On the letterhead of the organization/individual entrepreneur

Application
for Generation of the Electronic Signature Verification Key Certificate

1.	For the purpose of using in the Electronic Data Interchange System the organizer of which is Moscow Exchange 

_________________________________________________________________________________
(full name of the organization including the form of incorporation or full name of the individual entrepreneur)

represented by _____________________________________________________________________
(full name of the applicant acting on behalf of the legal entity – owner of the ESVKC)
hereby requests to produce ESVKC in accordance with the data specified in this application:

1.1.	 Attributes of the subject name (DN) for the ESVKC to be produced:
INN*	INN (Taxpayer Identification Number) of the organization/individual entrepreneur	
OGRN/OGRNIP**	OGRN (Primary State Registration Number) of the organization/OGRNIP of the individual entrepreneur	
SNILS***	Insurance Number of Individual Personal Account (SNILS) of the ESVKC owner	
title (T)	Position of the ESVKC owner	
commonName (CN)	First name, patronymic and last name of the ESVKC owner	
organizationUnitName (OU)	Division of the organization (shall not populate the field for the individual entrepreneur)	
organizationName (O)	Organization/individual entrepreneur name	
localityName (L)	Settlement name	
stateOrProvinceName (ST)	Name of the territorial subject
(for example, KZ Republic of Kazakhstan)	
* for EDI Participants registered with the Russian tax authorities
** for EDI Participants registered in the Russian Federation
*** for ESVKC holders who are citizens of the Russian Federation
2.	Applicant authentication:
  in person;
  not in person, but using a valid qualified electronic signature;
  without the applicant being present in person using the services of a notary.
3.	The Owner of the ESVKC being produced shall act on the basis of:
  foundation documents (Articles of Association);
  Is an individual entrepreneur;
  power of attorney.
4.	Tariff (option for creating ESVKC) for making changes to the current ESVKC:
  сreating an ESVKC;
  replacing an existing ESVKC to introduce changes.
5.	Contracts from the EDI Participant:
Name and surname:			. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Telephone number:		. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Email:			. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ESVKC owner (a person acting							_______________		______________________
on behalf of the EDI Participant)                         (signature)                            	(initials, last name)

___________________ 20___ (date)