PDF《解除被锁定智能权标服务申请》

解除被锁定智能权标服务申请表 FORM REF: CTT-DSCE-RelBlockedTokenReq-2017-11-v01p Page

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2 Request Form for Release a Blocked Smart Token 解除被锁定智能权标服务申请 Request for Release a Blocked Smart Token 日期 Date : 工作档案编号 WS.

No.: 请以英文正楷填写 (标明除外).Please complete this application form in English and in Block letters (except where otherwise specified). 请在合适的方格内加上 X .Please put a X in the appropriate boxes. 第一部分 C 徵求者资料 Section

1 C Requestor Details 客户编号 Cust. Ref. No. 徵求者类别 Requestor Type 证书登记人本人 登记人机构获授权代表 Certificate Subscriber Authorised Delegate of Subscriber Organisation 登记人之获授权代表 登记人或登记人机构之合法代理人 Authorised representative of Subscriber Legal representative of Subscriber or Subscriber Organisation 其他: Other 姓名 Name (中文 / In Chinese) 男性 Male 女性 Female (葡文或英文 / In Portuguese or English) (姓/Last Name) (名/First Name) 证件类别 Type of ID Card / Passport 澳门居民身份证 中国护照 往来港澳通行证 BIR PRC Passport PRC Travel permit for HKSAR &

MSAR 香港身份证 其他??0??护照或身份证明文件: HK ID Card Other National/Regional Passport/ID 证件号码 ID No./ Passport No. 签发地点 Place of Issue 澳门 其他: Macao Other 本次签发日期 Current Issue Date / / _ ( 日DD/月MM/年YYYY)国籍 (非持有澳门居民身份证必须填写) Nationality (Non BIR holder is required to fill in) 机构名称 Organisation Name (如适用 if applicable) (中文 / In Chinese) (葡文或英文 / In Port. or Eng.) 部门 / 分部 Department / Branch (如适用 if applicable) 职务 / 职级 / 职位 Position / Category (如适用 if applicable) 联络电话 Contact No. 传真号码 Fax No. 联络电邮 E-mail Contact 第二部份 C 服务申请详情 Section

2 C Service RequestDetails 产品名称 Product Name 合格电子签名套装 (注1) 高级电子签名套装 (注1) 加密证书 QES Pack (Remark 1) AES Pack (Remark 1) Encipherment Certificate 加密证书 (部门) Encipherment Certificate (For Unit) 权标序号 Token Serial No. 解除原因 Reason for Release 更改个人识别码 Change PIN 忘记个人识别码 Forgotten PIN 权标被锁定 Token being blocked 其他: Other 本人现向澳门邮电电子认证服务( eSignTrust ) 要求解除上述被锁定之智能权标.本人知悉 eSignTrust 仅在收到已签署的申请表正本及当 所徵求服务被确实后,以及本人须亲携上述被锁定智能权标到 eSignTrust 注册署,eSignTrust 才会解除上述被锁定之智能权标. I hereby request Macao Post eSignTrust Certification Services ( eSignTrust ) to release the aforesaid Blocked Token. I acknowledge that eSignTrust will only release the aforesaid Blocked Token if the duly-signed Request Form is received and the Release Request is verified;

and that I am required to go in person with the aforesaid Blocked Token to eSignTrust Registration Authority. 徵求者签署 (机构授权代签,如合适) Signature of Requestor (for and on behalf of the Organisation, where applicable) 签署: Signature 日期: Date ( 日DD/月MM/年YYYY)时间: Time ( 时:分,上午/下午)(Hour:Minute,AM/PM)机构名称 + 盖章(如合适) Organisation Name + Chop (where applicable) 解除被锁定智能权标服务申请表 FORM REF: CTT-DSCE-RelBlockedTokenReq-2017-11-v01p Page

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2 Request Form for Release a Blocked Smart Token 解除被锁定智能权标服务申请 Request for Release a Blocked Smart Token 日期 Date : 工作档案编号 WS. No.: 第三部份 C 服务接收确认 Section