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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