www.suryanarayana.com  

DATA for Director Identification Number & Digital Signature Certificate Applications

         #This form shall be submitted separately for each Director of existing or proposed Company. 
#Your answers shall be in CAPITAL LETTERS. 
#Fields beginning with * mark are required to be filled in to successfully submit this Form online.
#If you are unable to submit the Form online [when you are connected to internet], you can click DOWNLOAD button in the end of this page to open & save on your PC to fill, print and send this Form by Fax & Courier.

 

DIRECTOR Name in full with surname [Initials or abbreviations should not be entered for example KUMAR should be entered instead of K ] *
Occupation: [eg: Business / Employed / Housewife] *
Date of Birth:[DD-MM-YEAR ] *
Place of Birth: *
Father’s complete Name [to be mentioned even in case of married persons] *
Husband Name
Residential Address *

 

City / Town *
Pin code *
eMail ID: (if eMail id is not available, I need to generate eMail as: xxxx@suryanarayana.com )
Phone Number (s) [prefix with STD code ] *
Fax Number (s) [prefix with STD code
Names of other Companies if already Director / Promoter: [Please mention Company Indetentification Number also]
Income Tax Permanent Account Number [PAN]
Voter's identity card number :
Passport number :
Driving license number:
Enclosures: (A)Pass Port Size Photos [One photo with signature accross photo + One photo without signature]
(B)Proof of identity [Choose any one of the following documents in which name and date of birth are exactly matching with the description mentioned in column 1 above. Xerox copy should be certified / attested by public notary or gazetted officer or Practicing Company.]:

[Please Tick your option]

 *

(1) Passport
 

(2) Election (Voter identity) Card
 

(3) Driving license
 

(4) Income Tax PAN card

(5) Others [please specify]
(C)Proof of residence: [Choose any one of the following documents in which address is exactly matching with the description mentioned in column 7 above. Xerox copy should be certified / attested by public notary or gazetted officer or Practicing Company.]: *

(1) Passport
 

(2) Election (Voter identity) Card
 

(3) Ration Card
 

(4) Driving license

(5) Electricity Bill

(6) Telephone Bill
 

(7) Bank Account Statement
The information furnished above is true and correct to the best of my knowledge. Yes
I attach herewith the following scanned copies created in pdf format with size less than one MB [please upload only pdf files for example: photo.pdf or Director-1-Identity.pdf or Director-AddressProof.pdf ]
The above information furnished by: [Please write your NAME ] *
Your Email Address: *

If you are unable to submit the Form online [when you are connected to internet], you can click this DOWNLOAD button to open & save on your PC to fill, print and send this Form by Fax  &  Courier.