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5. Signatory’s work phone
4. Signatory’s work address
3. Signatory’s e-mail for which the certificate is issued
2. Signatory’s Personal Identification Number or date of birth(yymmdd)
Spektar Org
®
Revision: 1.4/29.01.08
Form 2.1
Application form for Spektar Org Universal Certificate
FORM 2.1
APPLICATION
APPLICANT
REGISTRATION NUMBER given at registration on the certification services provider’s website
To be filled in by the
Date
/
/
ã.
Spektar OrgUniversal Certificate
².
Electronically certificated information
FIELD
CONTENT
1. Signatory’s name in full
John Jameson
for example
for example
for example: street,¹,block,entr.,city,*country.
1234567890
jjameson@spektar.org
Karnegi 11A,Sofia
+359 2 9688 180
1
6. *Reason for giving representative powers to the Signatory
accountant, 318.123/01.07.05
7. Name of the organization/ trader Owner
for example capacity,¹ of notary public, ¹ letter of attorney /date.month.year
Spektar AD
8. Identification Number*,BULSTAT*, VAT* No
831431322, BG831431322
for example
for example
for example
for example
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10. Region of the management address of the Owner
2
9. *Court or other registration
SGS,FD,1234/90
for example: court, case type, case ¹ /year
for example
Sofia
11. Management address of the Owner as in the certificate of current status or in a document of creation
for example: str,¹,block,entr,city
Karnegi 11A,Sofia
12. Postal code of the management address of the Owner
13. Country
II. Additional data concerning the SIGNATORY, which are not certified electronically
Permanent address as in ID card:
Region
, country
town
str./quarter
, ¹
,
block
, entr.
, floor
, app./flat
Postal code
ID card ¹, date of issue (dd,mm,yyyy), valid until
¹
, issued on
20
, valid until
20
III. Additional data concerning the OWNER
Responsible Person
Invoice addressee
Contact phone number of the invoice addressee
IV. Information for additional identification/check
The PROVIDER uses this password (between 4 and 8 symbols) for authentication in case of forgotten log in password in the personal profile and in case of application for termination of the certificate.
Password
For example:
R2DI5N78
Owner’s SIGNATURE:
.
.
.
.
Spektar Org
®
Revision: 1.4/29.01.08
Form 2.1
Application form for Spektar Org Universal Certificate
UK
for example
,