www.lawcommission.gov.np Schedule–2 (Relating to Sub-rule (1) of Rule 12) The Controller, Subject: Request for issuance of a licence to work as a Certifying Authority I/We, hereby, submit this application to carry out business as a Certifying Authority in accordance with the Electronic Transaction Act, 2063 (2006) and the Electronic Transaction Rules, 2064 (2007). I/We, hereby, request to obtain the licence as the Certifying Authority. (A) Individual/ Firm or Company’s: 1. Name: 2. Address of the Registered Office: 3. Addresses of other branch offices where transactions have been made: 4. P.E.N number and name and address of the office issuing it: 5. Name and address of I.S.P.: 6. Website Address: 7. E-mail, Telephone and Fax No.:- 8. Full Name, surname and address of all persons holding 10% or more ownership or partnership of shares: 9. Paid issued capital/Total Assets: - 10. Total transaction of the previous year: - 11. Type of the digital signature as intended to be certified: - 12. Place in Nepal where the facility of certification shall be available:- 30 www.lawcommission.gov.np