EV CERTIFICATE REQUEST

An EV Certificate request form must be completed prior any EV Certificate being issued. This form may be used to
request multiple EV Certificates, each of which will be issued to a single domain. Each EV Certificate will contain the
information listed herein. If unique information (besides the domain is required, use a separate request form for each EV
Certificate.
Organization Name!
The formal legal name and address as recorded or specified with the Incorporating Agency.
Address!
City and "tate (if any!
"tate or pro#ince (if any!
$ostal code (%ip code! Country!
&ain telephone number!
Assumed Name (optional)
If desired, Applicant may include an assumed name (e.g., d/b/a name) in the EV ertificate, pro!ided the assumed name
is recorded in the "urisdiction of Applicant#s $lace of %usiness.
!omain Name(s) (one per line)
Each domain name will re&uire the !alidation and issuance of its own independent EV ertificate.
In"orporation or Registration Agen"#
Incorporating'(egistration Agency!
)urisdiction of Incorporation City or town (if any!
"tate or pro#ince of Incorporation (if any!
Country of Incorporation!
(egistration *umber (if any!
As assigned by the Incorporating Agency (for $ri!ate 'rgani(ation Applicants only).
Certi$i"ate Re%uester& Appro'er& and Contra"t Signer
*ame!
Title or $osition!
Address!
City! "tate!
Country!
+irect telephone number! Email Address!
This form assumes a single person will be acting as the ertificate )e&uester, ertificate Appro!er, and ontractor
*igner. If separate roles are re&uired, please use the following form instead+ (lin,)
Certi$i"ation
I, , request the issuance of EV Certificates for the domains listed herein and
certify that the information herein is true and correct! I guarantee the accuracy, authenticity and completeness of the
information pro#ided in this EV Certificate (equest ,orm. I will immediately bring any changes or inaccuracies to
Comodo-s attention. I agree that failure to do so may result in the re#ocation of the EV Certificate and litigation by
Comodo against the company, its affiliates and'or me.
"igned! +ate!
US (ead%uarters E)EA (ead%uarters
./. 0ashington 1l#d 2ffice Village 3
rd
,loor
"uite 4566 E7change 8uay, Trafford (d
)ersey City "alford, &anchester
*) 69346 :"A , &. 3E8 , :nited ;ingdom
Tel: <4 /64 =>3 6665 Tel: < 55 (6 4>4 ?95 9696
Registered in England Registration No *+,-..*/ VAT No 01 2*, 2345 +4/ Registered O$$i"e E6"7ange Qua# Tra$$ord Rd/ Sal$ord )an"7ester )4 ,(1