Division 5 Contact persons and trusted couriers identification form (sample)
United Kingdom
I, [name and address of the organisation representative], certifies that the following information are to be used in the context of the request, generation and retrieval of public key digital certificates for TACHOnet access points supporting the confidentiality, integrity and non-repudiation of the TACHOnet messages:
Contact person information:
| — Contact person #1 | — Contact person #2 |
|---|---|
| — Name: | — Name: |
| — First names: | — First names: |
| — Mobile phone: | — Mobile phone: |
| — Telephone: | — Telephone: |
| — Email: | — Email: |
| — Specimen handwritten signature: — | — Specimen handwritten signature: — — — |
Trusted courier information:
| — Trusted courier #1 | — Trusted courier #2 |
|---|---|
| — Name: | — Name: |
| — First names: | — First names: |
| — Mobile phone: | — Mobile phone: |
| — Email: | — Email: |
| — Passport issuing country: | — Passport issuing country: |
| — Passport number: | — Passport number: |
| — Passport validity end date: | — Passport validity end date: |
Place, date, company stamp or seal of the Organisation:
Signature of the authorised representative: