PSIRA Renewal Form - - Fill, Sign Online, Download & Print - No Signup

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APPLICATION

01

RENEWAL

02

RE-ISSUE

03

UPGRADE

/

/

Application Date (dd/mm/yyyy)

PARTICULARS OF APPLICANT

South African Identification Number / Permit number / Asylum

papers

PSiRA Number

Surname

Full Names

PLEASE TICK

MALE

FEMALE

03

UPGRADE

04

CLOSE

CORPORATION

PHYSICAL ADDRESS OF APPLICANT

Postal Code

POSTAL ADDRESS (if different to Physical Address)

Postal Code

TELEPHONE NUMBERS (Code/Number)

Business

Fax

Cellphone

____________________________________________________

Email address

IS THE APPLICANT EMPLOYED? YES NO

CURRENT EMPLOYER: EMPLOYEE NUMBER:

THE DIRECTOR

PRIVATE SECURITY INDUSTRY

REGULATORY AUTHORITY

PRIVATE BAG X817

PRETORIA

0001

Private Security Industry

Regulatory Authority (SIRA)

Application for registration as a security service

provider in terms of the Private Security Industry

Regulation Act 56 of 2001 (“the Act”)

APPLICATION FOR RENEWAL OF

INDIVIDUAL CERTIFICATE

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I the undersigned, ______________________________________________________________________

(Full Name and identity number)

declare that I have taken note of the minimum requirements for registration and that the information furnished on this application form is,

to the best of my knowledge, true and complete. I agree that the Private Security Industry Regulatory Authority may summarily

approvereject my application in case any of the informationrecord(s) furnished above are found to be incorrect or false and will not make

any correspondence in the matter whatsoever, I will abide by the decision of the Private Security Industry Regulatory Authority.

THIS DONE AND SIGNED

at

on

Of 20_____

SIGNATURE:

FOR OFFICE USE ONLY

1. Confirmation of registration with PSiRA

YES/NO

2. Confirmation of Grades or any other course

YES/NO

3. Confirmation of identification with DHA

YES/NO

4. Payment confirmed

YES/NO

I hereby confirm that the application was complete and correct

Name of PSiRA official___________________ Signature____________________

Date _______________________

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