Proof Old Certificateaffidavit in Case of Loss Th 2020-2026

Proof Old certificate/affidavit in case of loss theft etc 9. Total amount to be paid R I have confirmed the above to be correct Name of PSIRA official-------------------------------Signature------------------------------------------------Date ------------------------------------------------------ Security Industry Regulatory Authority Renewal of certificate Checklist - Business Date REQUIREMENT Application letter from business printed on business letterhead Original valid tax clearance certificate Payment of prescribed amount R250. Private Security Industry Regulatory Authority SIRA THE DIRECTOR PRIVATE SECURITY INDUSTRY REGULATORY AUTHORITY PRIVATE BAG X817 PRETORIA 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 BUSINESS CERTIFICATE RENEWAL / REISSUE Application Date dd/mm/yyyy PARTICULARS OF THE BUSINESS Business Name PSiRA Number Size of Business Please tick SMALL MEDIUM SA Ownership LARGE Turnover of R5-35 Million rand a year Turnover of 0R15Million rand a year Turnover of above 35 Million a year Foreign Ownership BEE Level Please tick BLACK OWNED WHITE OWNED Note If the Business address has changed a change of address fee must be paid before a new certificate is printed. PHYSICAL ADDRESS OF THE BUSINESS Postal Code POSTAL ADDRESS if different to Physical Address TELEPHONE NUMBERS Code/Number Fax Business Email address I the undersigned Full name and identity number declares that the information furnished on this form is true and complete to the best of my knowledge. I agree that Private Security Industry incorrect or false and I will not make any correspondence in the matter whatsoever and I will abide by the decision of the Private Security Industry regulatory Authority. Page 1 of 3 Pages Cellphone THUS DONE AND SIGNED at on Of 20 SIGNATURE FOR OFFICE USE ONLY 1. Purpose of the visit collection of new certificate/ re issue/upgrade 2. Confirmation of business registration with PSIRA YES/NO 6. PSIRA fees paid in full 7. Submission of original valid Tax clearance certificate 8. 00 First issue / R500. 00 2nd issue and R1500 3rd issue Proof of old certificate or Affidavit in case of a loss theft etc Annual fees paid in full o. I agree that Private Security Industry incorrect or false and I will not make any correspondence in the matter whatsoever and I will abide by the decision of the Private Security Industry regulatory Authority. Page 1 of 3 Pages Cellphone THUS DONE AND SIGNED at on Of 20 SIGNATURE FOR OFFICE USE ONLY 1. Purpose of the visit collection of new certificate/ re issue/upgrade 2. Page 1 of 3 Pages Cellphone THUS DONE AND SIGNED at on Of 20 SIGNATURE FOR OFFICE USE ONLY 1. Purpose of the visit collection of new certificate/ re issue/upgrade 2. Confirmation of business registration with PSIRA YES/NO 6. PSIRA fees paid in full 7. Submission of original valid Tax clearance certificate 8. I agree that Private Security Industry incorrect or false and I will not make any correspondence in the matter whatsoever and I will abide by the decision of the Private Security Industry regulatory Authority. Page 1 of 3 Pages Cellphone THUS DONE AND SIGNED at on Of 20 SIGNATURE FOR OFFICE USE ONLY 1. Purpose of the visit collection of new certificate/ re issue/upgrade 2. Confirmation of business registration with PSIRA YES/NO 6. PSIRA fees paid in full 7. Submission of original valid Tax clearance certificate 8.