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Psa-Form V

This is an application form for obtaining a new license or renewing an existing license to operate a private security agency. It requests information such as the applicant's name, address, details of the proposed security agency like its name and address, facilities and equipment available, qualifications of staff, uniform details, intended areas of operation, and required enclosures like an income tax clearance certificate and affidavit. The purpose is to collect necessary details to process and approve the application for a private security agency license.

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Vinod Vinz
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26 views

Psa-Form V

This is an application form for obtaining a new license or renewing an existing license to operate a private security agency. It requests information such as the applicant's name, address, details of the proposed security agency like its name and address, facilities and equipment available, qualifications of staff, uniform details, intended areas of operation, and required enclosures like an income tax clearance certificate and affidavit. The purpose is to collect necessary details to process and approve the application for a private security agency license.

Uploaded by

Vinod Vinz
Copyright
© © All Rights Reserved
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Form V

(See rule 8)
APPLICATION FOR NEW LICENCE / RENEWAL OF LICENCE TO ENGAGE IN
THE BUSINESS OF PRIVATE SECURITY AGENCY
To,
The Controlling Authority &
Additional Director General of Police,
Internal Security Division, Bangalore.
The undersigned hereby alies for obtaining a !icence to run the business of oerating
services in the area of Private Security Agencies.
"# $ull %a&e of the Alicant'
(# %ationality of the Alicant'
)# Son* +ife* Daughter of'
,# -esidential Address'
.# Address, /here the alicant
Desires to Start his Agency'
0# %a&e of the Private Security Agency'
1# %a&e & Address of the Prorietor,
Partner, 2a3ority shareholder,
Director and Chair&an of the Agency'
4# %a&e and e5tent of facilities available'
6# 7ualification of staff engaged for
I&arting instruction'
%a&e'
Age'
Designation'
"8# 9:ui&ents /hich /ill be used for Security Services.
a# Door fra&ed &etal Detector ;D$2D#
b# <and <eld 2etal Detector ;<<2D#
c# 2ine Detector
d# =ther Detectors
i# +ireless Telehones
ii# Alar& Devices
iii# Ar&ored >ehicles
iv# Ar&s
"
""# The articulars of the unifor& including color in case the alicant intends to use a
unifor& for the Private Security Guards and Suervisor of the Agency.

"(# Does the Alicant intends to oerate in &ore than one District? If so the na&e of the
District "#@@@@@@@@@@@@@ (#@@@@@@@@@@@@@@@@ )#@@@@@@@@@@@@@@ ,#@@@@@@@@@@@@@@
.#@@@@@@@@@@@@@@@@
")# Does the Alicant intend to oerate in the 9ntire State?
",# Does the Alicant ossesses the training facility in its o/n or /ill get it on outsourcing
basis? The na&e and address of training facility should be furnished.
Signature
%a&e of the Alicant
Address of the Alicant
Telehone %u&ber of the Alicant
Date of Alication
9nclosure'
"# Coy of current Inco&e Ta5 clearance Certificate.
(# Affidavit as rescribed in Section 1 subAsection ;(# of the Act.
)# =ther 9nclosures.


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