form Gen-Fiz-DP-2.1-en

valid from 4th February, 2005

page1

/ SIGEN-CA
Certification Authority at the Ministry of Public Administration
Tržaška cesta 21, SI-1000 Ljubljana, Slovenia

/

Application form for acquiring web digital certificates

SIGEN-CA (Slovenian General Certification Authority) is a certification authority at the Ministry of Public Administration. General conditions are defined in SIGEN-CA Policy for qualified digital certificates for natural persons. Web certificate contains: distinguished name with holder'sname and surname, serial number, period of certificate validity, SIGEN-CA name, public key and other information according to SIGEN-CA policy. Other personal data will not be used for any unintended purposes.

The application form is filled in by a future holder (section Digital certificate holder's data). The future holder hands in the application form in person at registration authority[1] by presenting a valid identification document. The future holder guarantees the validity of data by his/her signature.

Digital certificate holder’s data

Given name: / Family name:
Personal ID number[2]: / Tax ID number2:

Permanent residence address

Settlement:
Street:
House number:
City code:
City:
State:

Address, where I would like to receive information from SIGEN-CA

Permanent residence address
Other address:
Settlement:
Street:
House number:
City code:
City:
State:
E-mail:
Password for certificate revocation[3]:
Telephone number:

I agree that my personal data are acquired from the state registers and databases for the purpose of filling in this application form. Herewith I confirm with my signature that I agree with conditions stated in SIGEN-CA policy and confirm the verity of data given in the application form. I agree that in case of SIGEN-CA policy modification[4], the certificate applied with this application form can be issued according to the new policy. I authorize SIGEN-CA to process my personal data from this application form for the purpose of e-services and according to conditions stated in SIGEN-CA Policy and in accordance with valid legislation.

Name of legal representative:[5]
Signature of legal representative: / Future holder’s signature:

1/2

[1] The list of registration authorities is published on web site

[2] Data is needed for e-services according to conditions defined in SIGEN-CA policy.

[3] Password for certificate revocation by telephone, maximum length allowed 20 alphanumeric characters

[4] In case of SIGEN-CA policy modification, the new policy is published 8 days before coming to force.

[5] In case the future holder is a person without procedural capacity, his/her legal representative must give confirmation by signing the application form. Legal representative must be also present when handing in the application form at RA by the future holder.