S.L. 389.1 Art. 13is, to the in accordance inform the 1. Details 1.1 ID Number Date and 2. Full 3. Details 3.1 3.2 Has prison 3.3 The 4. The 5. The declaration proceedings 6. I of V.A.T. and purpose of the

Applicant’s declaration

I hereby declare that the information contained in this application best of my knowledge and belief, true and correct, and I undertake that with the provisions of article 12(1)(c) of the Act, I shall immediately Commissioner of any change in the information herein contained. 13.1 Applicant’s name .................................................. Designation ..........................................................

Signature .............................................................. THIRD SCHEDULE

(Regulation 7(1))

Private Guards and Community Officers Act Application for a licence of a Private Guard in terms of article 6 of Applicant

Applicant’s Name and Surname Address

Place of Birth

Details of Working Experience:

..................................................................................................................... ..................................................................................................................... ..................................................................................................................... ..................................................................................................................... of Employment Applicant’s present employment

..................................................................................................................... .....................................................................................................................

Applicant ever been employed with the Police, armed forces or the services?

..................................................................................................................... ..................................................................................................................... ..................................................................................................................... cause of the termination of such employment (if applicable).

..................................................................................................................... ..................................................................................................................... ..................................................................................................................... ..................................................................................................................... Academic, training and other qualifications: ..................................................................................................................... ..................................................................................................................... ..................................................................................................................... .....................................................................................................................

Applicant is to produce the relevant academic and training certificates. Financial Status Applicant is to produce with this application a sworn/solemn that he has not been declared bankrupt and that no such bankruptcy have been commenced. Authorisation for the purpose of article 10(a)(ii) of the Act. hereby authorise the Commissioner of Inland Revenue, the Commissioner any Bank Manager to disclose any information that may be required by the Commissioner of Police to ascertain my financial position for the Private Guards and Community Officers Act. 6.1 Applicant’s name ......................................

Signature .................................................