THE SCHEDULE
[See section 63(4)(c)]
CERTIFICATE

PART A
(To be filled by the Party)
I, _____________________ (Name), Son/daughter/spouse of ___________________
residing/employed at __________________________ do hereby solemnly affirm and sincerely
state and submit as follows:—
I have produced electronic record/output of the digital record taken from the following
device/digital record source (tick mark):—
Computer / Storage Media □ DVR □ Mobile □ Flash Drive □
CD/DVD □ Server □ Cloud □ Other □
Other: ________________________________________
Make & Model: _______________ Color: _______________
Serial Number: _______________
IMEI/UIN/UID/MAC/Cloud ID_____________________ (as applicable)
and any other relevant information, if any, about the device/digital record____(specify).
The digital device or the digital record source was under the lawful control for regularly
creating, storing or processing information for the purposes of carrying out regular activities
and during this period, the computer or the communication device was working properly and
the relevant information was regularly fed into the computer during the ordinary course of
business. If the computer/digital device at any point of time was not working properly or out
of operation, then it has not affected the electro nic/digital record or its accuracy. The digital
device or the source of the digital record is:—
Owned □ Maintained □ Managed □ Operated□
by me (select as applicable).
I state that the HASH value/s of the electronic/digital record/s is _________________,
obtained through the following algorithm:—
□ SHA1:
□ SHA256:
□ MD5:
□ Other__________________ (Legally acceptable standard)
(Hash report to be enclosed with the certificate)
(Name and signature)
Date (DD/MM/YYYY): _____
Time (IST): ________hours (In 24 hours format)
Place: ____________

PART B
(To be filled by the Expert)
I, ____________________ (Name), Son/daughter/spouse of ____________________
residing/employed at _________________________ do hereby solemnly affirm and
sincerely state and submit as follows:—
The produced electronic record/output of the digital record are obtained from the following
device/digital record source (tick mark):—
Computer / Storage Media □ DVR □ Mobile □ Flash Drive □
CD/DVD □ Server □ Cloud □ Other □
Other: ________________________________________
Make & Model: _______________ Color: _______________
Serial Number: _______________
IMEI/UIN/UID/MAC/Cloud ID_____________________ (as applicable)
and any other relevant information, if any, about the device/digital record_______(specify).
I state that the HASH value/s of the electronic/digital record/s is _____________________,
obtained through the following algorithm:—
□ SHA1:
□ SHA256:
□ MD5:
□ Other__________________ (Legally acceptable standard)
(Hash report to be enclosed with the certificate)
(Name, designation and signature)
Date (DD/MM/YYYY): _____
Time (IST): ________hours (In 24 hours format)
Place: ____________