PRIVATE SECURITY INDUSTRY
REGULATORY AUTHORITY
PRIVATE BAG X817
PRETORIA
0001
Private Security Industry
Regulatory Authority (PSIRA)
Tel
(012)
003337-5506/72/19/13
0500/1
Telno:
no:
(012)
086Fax
133no:
3850(012 328-3862
Fax no: 086 219 0810
APPLICATION TO OCCUPY/ASSUME A POSITION AS OWNER/DIRECTOR/MEMBER/PARTNER/ TRUSTEE OF
A SECURITY BUSINESS IN TERMS OF SECTION 21(1)((a)(ii), (iii), (iv), (v) (vi) or (vii) OF THE PRIVATE
SECURITY INDUSTRY REGULATION ACT, 2001 (Act No. 56 of 2001) [PSIRA-41]
Name of
owner/director/members/partner/trustee/administrator/manager
PSIRA Registration Number
Identity number
Effective Date
I, the undersigned, duly authorized by the applicant business, hereby warrant that the information furnished
in this application, as well as any documentation submitted in support of this application is, to the best of
my knowledge, true and correct.
Date:
Signature of
owner/director/
member/partner/
trustee/
administrator/manager
Name of owner/
director/member/
partner/trustee/
administrator/manager
duly authorized
NOTE:
This application must be accompanied by:

Payment of the prescribed fee of R430.00;
UPON APPROVAL BY THE AUTHORITY TO OCCUPY OR ASSUME A POSITION AS A
OWNER/DIRECTOR/ MEMBER/PARTNER/TRUSTEE/ADMINISTRATOR/MANAGER THE
FOLLOWING DOCUMENTATION SHOULD BE SUBMITTED TO THE AUTHORITY:




An authenticated copy of the CM29 documentation in respect of the change of Directors if the
security business is a company;
An authenticated copy of the CK2 documentation in respect of the change of members if the
security business is a close corporation;
An authenticated copy of the agreement to change the name if the partners if the security business is a
partnership;
An authenticated copy of the authorization from the Master of the High Court to change the trustees if
the security business is a trust;
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

An authenticated copy of the documentation to change the administrator if the security business is a
foundation;
A resolution in such format as may be prescribed by the Authority passed at a duly constituted
meeting of the owners/directors/members/trustee/partners/foundation of the security business
authorizing the owner/director/member/partner/trustee/foundation signing this application to do so.
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Specimen resolution to be submitted with application to occupy or assume the position of
owner/director/member/partner/trustee/administrator/manager of a registered security
service provider (security business)
BUSINESS LETTERHEAD
Resolution passed at a duly constituted meeting of the
(owner/directors/members/trustees/partners/administrator/manager)
(registered
name of business),
(place) at
of
(registration number) held at
(time) on
(date).
Resolved:
That
21(1)((a)(ii),
(name of natural person) in terms of Section
(iii), (iv), (v) (vi) or (vii) of The Private Security Industry Regulation Act, 2001 (Act No. 56 of 2001) apply to occupy
or
assume the position of owners/directors/members/trustees/partners/administrator/manager of
(security business name),
Specimen signature of duly authorized person
Certified Correct
Name
Capacity
Signature
Date
Name
Capacity
Signature
Date
Name
Capacity
Signature
Date
Name
Capacity
Signature
Date
Name
Capacity
Signature
Date
Name
Capacity
Signature
Date
(all owners/directors/members/trustees/partners to sign)
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