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     SAMPLE APPLICATION FORM FOR SERVER CERTIFICATES

Please fill the form and send it to the PRAGMA-UCSD CA Registration
Authority (pragma-grid-ca at sdsc.edu).

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1. Purpose of this application (new or renew, select one)
  - new

2. Name:
Yoshio Tanaka

3. Affiliation:
National Institute of Advanced Industrial Science and Technology

4. Address:
Tsukuba Central 2, Umezono 1-1-1, Tsukuba, Ibaraki 3058568, Japan

5. Phone Number:
+81-12-3456789

6. Fax Number:
+81-12-3456789

7. Email address:
yoshio@test.aist.go.jp

8. Hostname(s) of certificate(s) requested (abbreviation is acceptable):
karubi[0-3].aist.go.jp
kuppa.aist.go.jp
kimuchi01.aist.go.jp
kimuchi02.aist.go.jp
...
kimuchi32.aist.go.jp

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