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:-

(B) Documents Attached:
1. Firm/Company Registration Certificate,
2. Audit Report of the previous year,
3. The details of the certification process intended to be used while
working as a Certifying Authority,
4. Certificate of tax clearance for up to the previous fiscal year,
5. Performance Bank Guarantee,
6. Bank Voucher or Receipt deposited for application fee,

7. Details exhibiting working experience in the related sector,
8. Attested copy of decision made by the Board of Directors to file an application in case of a firm or a company,
9. Other necessary documents required to be certify the qualification as referred to in Sub-rule (1) of Rule 12.
The qualification, to be met under the Electronic Transaction Act, 2064 (2006) and the Electronic Transaction Rules, 2064 (2007) has been met to work as a Certifying Authority and the details mentioned herein are true; if proved otherwise, I shall be liable to the consequence in accordance with law.
Seal of the Firm or Company Applicant’s
Signature: –
Name: –
Designation:
Date: