(1) Notwithstanding whether the Agency mandates its private security guards to put on uniform while on duty or not, every private security agency shall issue and make it obligatory for its security guards to put on:
(a) an arm badge distinguishing the Agency;
(b) shoulder or chest badge to indicate his position in the organization;
(c) whistle attached to the whistle cord and to be kept in the left pocket;
(d) shoes with eyelet and laces;
(e) a headgear which may also carry the distinguishing mark of the Agency.
(2) The clothes wear by the private security guard while on active duty shall be such that they do not hamper in his efficient performance. In particular they shall neither be too tight nor too loose as to obstruct movement or bending of limbs.
(3) Every private security guard shall carry a notebook and a writing instrument with him.
(4) Every private security guard while on active security duty shall wear and display photo-identity card issued under section 17 of the Act, on the outer most garment above waist level on his person in conspicuous manner.
[भाग II—खण् ड 3(i)] भारत का राजपत्र : ऄसाधारण 27 Form I (See rule 3, 5) APPLICATION FOR GRANT OF LICENCE /RENEWAL OF LICENCE TO ENGAGE IN THE BUSINESS OF PRIVATE SECURITY AGENCY To The Controlling Authority _____________________ _____________________ The undersigned hereby applies for obtaining a licence to run the business of operating services in the area of Private Security Agencies
1. Full name of the applicant:
2. Nationality of the applicant:
3. Son/wife/daughter of:
4. Residential Address:
5. Address ,where the applicant desires to start his Agency:
6. Name of the Private Security Agency:
7. Additional details of the Private Security Agency (if applicable):
(a) CIN No…………………………
(b) ESI No……………………………
(c) EPF No…………………………
(d) Labour Licence No…………………….
(e) Labour Registration No…………………..
(f) GST No…………………………………
(g) Any other information………
(h) Whether the Agency has FDI? (Yes/No)……..
If Yes, Give the following information;
(i) Country of FDI :…………………………………
(ii) Name of foreign shareholder:………………….
(iii) Address of foreign shareholder :……………….
(iv) Year of investment:……………………………..
(v) No. of shares:……………………………………….
(vi) Percentage of foreign shareholding:………………
(vii) Approval details of FDI: ……………………………….
(Please attach the relevant document of FDI approval.)
8. Name and addresses of Proprietor, partner, Majority shareholder, Director and Chairman of the Agency:
S.No. Management Type (Proprietor/partner/Majority shareholder/Director/Chairman) Name Address DIN No. (if held) ID Proof with no.
28 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(i)]
9. Name and extent of facilities available:
10. (a) Does the applicant possesses the training facility in its own or will get it on outsourcing basis?..............……
(b) If the applicant has own training facility, please provide the following information:
Name of training agency:
Address of Training agency:
Recognition details of Training agency:………………………………………….
11. Equipments which will be used for Security services
(a) Door Framed Metal Detector (DFMD)
(b) Hand Held Metal Detector (HHMD)
(c) Mine Detector
(d) Other Equipments
(i) Wireless Telephones
(ii) Alarm Devices
(iii) Armoured Vehicles
(iv) Arms
12. The particulars of the uniform including color. (Please attach color photo of uniforms).
13. Does the applicant intends to operate in more than one districts? If so the name of the Districts
1.______ 2._______3._______4.________5.________
14. Does the applicant intend to operate in the entire state? Yes/No Signature Name of the applicant Address of the application Telephone number of the applicant Date of application Enclosure:
1. Photo of the premises of the Agency.
2. ID Proof of all Management personnel.
3. Recognition details of training agency (if applicable).
4. Colour photo of uniforms.
5. Documents (if applicable) under the agency details given in Para 7 above.
6. Copy of current Income tax Clearance Certificate.
7. Affidavit as prescribed in Section 7 sub-section (2) of the Act
8. Other enclosures.
[भाग II—खण् ड 3(i)] भारत का राजपत्र : ऄसाधारण 29 Form II (See rule 3 and 5) Form for verification of Antecedents of Applicant NOTE: If the applicant is a company, a firm or an association of persons, this form shall be filled up by every proprietor or majority shareholder, partner or director of the company, as if they are also the applicants.
Signature of the Applicant ---------------------------------------------------------------- For official use only Form number Antecedents verification issued by : Date Fee Amount Rs. --------------Cash /D.D. -------------Name of Bank ------------ D.D No. ----------- Date of Issue --------------- Please fill in BLOCK LETTERS: (CAUTION: Please furnish correct information. Furnishing of incorrect information or suppression of any factual information in the form will render the candidate unsuitable for grant of licence)
1. Name of applicant (Initials not allowed) Last name -------------------------------- First name-------------------------------
2. If you have ever changed your name, please indicate the previous name(s) in full ------------------------------------------------------------------------------------------------------------
3. Sex (male / female). ---
4. Date of Birth (DD/MM/YYYY): ------------------------
5. Aadhaar No.____________________
6. PAN No.________________________
7. Place of Birth: Village / Town ----------------------- District ---------------------------State and Country -------------------------------
8. Father's Full Name/ Legal Guardian's Full Name (including surname, if any): (Initials not allowed) ------- -----------------------------------------------------------------------------
9. Mother’s Full Name (including surname, if any): (Initials not allowed) --------------------------------------------------------------------------------------------------
10. If married, Full Name of Spouse (including surname, if any). (Initials not allowed) ------------------------------------------------------------------------------------------------------
11. Present Residential Address, including Street No./police station, village and District (with PIN code) ----------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------ Telephone No./Mobile No.-----------------------------------------------------
12. Please give the date since residing at the above-mentioned address: (DD/MM/YYYY)--------------------- --------------------------------------------------------------
13. Permanent Address including Street No./police station, village and District (with PIN code)--------------- ----------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------
14. If you have not resided at the address given at COLUMN (11) continuously for the last five years, please furnish the other address (addresses) with duration(s) resided.
From …………….To.…………… Address ___________________________ _____________________________ ___________________________ ______________________________ 30 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(i)]
15. In case of stay abroad particulars of all places where you have resided for more than one year after attaining the age of twenty-one years. ------------------------------------------------------
16. Other Details:
(a) Educational Qualifications. :
(b) Previous positions held if any along with name and address of employers:
(c) Reason for leaving last employment:
(d) Visible Distinguishing Mark:
(e) Last 3 years IT Return:
S.No. Assessment Year Copy of ITR enclosed (Yes/No)
1. ……………. …………………….
2. …………….. ……………………..
3. ………………… ………………………..
(f) Affidavit incorporating the provisions of Section 6 of the Act enclosed: Yes/No
17. Did you earlier operated any Private Security Agency or were its partner, majority shareholder or Director? If yes then furnish the name, address of the Agency and its licence particulars.
…………………………………………………………………..
18. Are you a citizen of India by: Birth/ Descent/Registration/Naturalisation: If you have ever possessed any other citizenship, please indicate previous citizenship ……………………….
19. Have you at any time been convicted by a court in India for any criminal offence and sentenced to imprisonment? If so, give name of the court, case number and offence. (Attach copy of judgment) ……………………………………………………………………………
20. Is/Are any criminal proceeding(s) pending against you before a court in India? If so, give name of court, case number and offence …………………………………………………………………………………………………
21. Self- Declaration:
The information given by me in this form and enclosures is true and I am solely responsible for accuracy.
(Signature of applicant) Date………….
Place ………… Enclosures:
…………………………………………………………………………………………………… …………………………………………………………………………………………… (Signature of applicant) Form-III (See rule 3(2)/ rule 5(1)) Affidavit I……………………………S/o / D/o / W/o Mr./Ms. ……………………..resident of ……………………………..is a Proprietor/ Partner/ Director of M/s………………………….. (Name of firm/agency/company) at ………………………. (Address of firm/agency/company). I do hereby solemnly affirm and declare as under:
1. That the deponent is a citizen of India.
[भाग II—खण् ड 3(i)] भारत का राजपत्र : ऄसाधारण 31
2. That the deponent has attained the age of 18 years.
3. That the details of the Proprietor/ Partners/ Directors (Please indicate the details of all the Partners/ Directors) are as under:
S.No. Name of the Proprietor/ Partners/ Directors Designations in the firm/agency/company (Proprietor/ Partner/ Director) Residential Address
4. That the deponent or any of the Proprietor/ Partner/ Director has not been convicted of any offence in connection with promotion, formation or management of a company (any fraud or misfeasance committed by him in relation to the firm/agency/company), including an undischarged insolvent.
5. That the deponent or any of the Proprietor/ Partner/ Director has not been convicted by a competent court for an offence, the prescribed punishment for which is imprisonment of not less than two years.
6. That the deponent or any of the Proprietor/ Partner/ Director has not been -
(a) keeping links with any organisation or association which is banned under any law on account of their activities which pose threat to national security or public order; or
(b) indulging in activities which are prejudicial to national security or public order.
7. That the deponent or any of the Proprietor/ Partner/ Director has not been dismissed or removed from Government service on grounds of misconduct or moral turpitude.
8. That the firm/agency/company is registered in India and does not have a proprietor or a majority shareholder, partner or director, who is not a citizen of India.
9. That the deponent and all the Partner/ Director of the firm/agency/company shall comply with the provisions of sub-section (2) of section 9 of the Private Security Agencies (Regulation) Act, 2005 (29 of 2005) by ensuring availability/imparting of such training and skills to its private security guards and supervisors as prescribed.
10. That the deponent and all the Partner/ Director of the firm/agency/company shall fulfill the following conditions of licence as stipulated under section 11 of the Private Security Agencies (Regulation) Act, 2005 (29 of 2005).
(i) prescribed training which the licensee is to undergo;
(ii) details of the person or persons forming the agency;
(iii) obligation as to the information to be provided from time to time to the Controlling Authority regarding any change in their address, change of management;
(iv) obligation as to the information to be provided from time to time to the Controlling Authority about any criminal charge made against them in the course of their performance of duties of the private security agency or as the case may be, a private security guard employed or engaged by them.
(v) Competent authority in the State Government/UT administration may verify about imparting of required training by the private security agency under sub-section (2) of section 9 of the Act and may review continuation or otherwise of licence of the private security agency if the agency have not adhered to the condition of ensuring the required training.
32 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(i)]
11. That there are no cases registered with police or pending in court of law against the deponent.
Or That there are cases registered with police or pending in court of law against the deponent. (Details shall be enclosed)
12. That the deponent and all the Partner/ Director of the firm/agency/company will comply, conditions of licence and in letter and spirit, with the provisions of the Private Security Agencies (Regulation) Act, 2005 (29 of 2005) and the relevant rules notified by the State Government/UT administration under the Act and also comply with the instructions issued from time to time by the Controlling Authority appointed under the Act, while managing private security agency with the name and title M/s……………………………………..
Deponent Verification:- I,…………………………. hereby solemnly affirm on ………..(date) that the contents of above this affidavit are true and correct to the best of my knowledge and belief nothing has been concealed therein.
Deponent Note: (i) Point No. 4 to 8 relates to compliance of section 6 of the Act.
(ii) Point No. 9 relates to compliance of section 9(2) of the Act.
(iii) Point No. 10 and 11 relates to compliance of section 11 of the Act.
(iv) Strike the points which are not applicable.
From IV (See rule 3(10)) GOVERNMENT OF______________ Licence to engage in the business of Private Security Agency Serial No--------- Date-------------- Name of the Private Security Agency:……………………………….
Shri.---------------------------------------------------(name of the Applicant) S/o ---------------------------------------------------------------r/o-------------------- -------------------------------------------------------------(Full Address)--------------------------------------------------- -----------------is granted the licence by the Controlling Officer for the State of ----------------------------------- ------------- to run the business of Private Security Agency in the district(s) of / State of ( strike of the inapplicable words) -------------------------------------------------------------------------------------------------------- -with office at ………(address of the office) Place of Issue ---------------- Date of issue ------------------ This license is valid up to --------------------------------- Signature Name of granting authority Designation Official Address [भाग II—खण् ड 3(i)] भारत का राजपत्र : ऄसाधारण 33 RENEWAL (See rule 5(4)) Sl. No. Date of Renewal Date of expiry
1.
2.
3.
4.
Signature Name of renewing authority Designation Official Address Form V (See rule 7(2)) Form for verification of Character and antecedents of Security Guard and Supervisor Signature of the Applicant --------------------------------- For official use only Form number Character & antecedents verification issued by : Date Fee Amount Rs. ------------Cash /D.D ------------Name of Bank ------------ D.D No. ----- Date of Issue --------------- Please fill in BLOCK LETTERS: (CAUTION: Please furnish correct information.
Furnishing of incorrect information or suppression of any factual information in the form will render the candidate unsuitable for employment /engagement in the Private Security Agency.)
1. Name of applicant as should appear in the photo-identity card (Initials not allowed) Last name _________________ First name____________________________
2. If you have ever changed your name, please indicate the previous name(s) in full _________________________________________________________________
3. Sex (male/female). _________________________
4. Date of Birth (DD/MM/YYYY): _____________
5. Aadhaar No.______________________________
6. Place of Birth: Village / Town ________________ District ______________________State and Country __________________________________
7. Father's Full Name/ Legal Guardian's Full Name (including surname, if any): (Initials not allowed) ------- -----------------------------------------------------------------------------
8. Mother’s Full Name (including surname, if any): (Initials not allowed) -------------------------------------------------------------------------------------------------- 34 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(i)]
9. If married, Full Name of Spouse (including surname, if any). (Initials not allowed) ------------------------------------------------------------------------------------------------------
10. Present Residential Address, including Street No. /police station, village and District (with PIN code) --------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------- Telephone No./Mobile No.------------------------------------------------------------------------
11. Please give the date since residing at the above mentioned address: DD/MM/YYYY ---------------------------------------------------------------------------------------
12. Permanent Address including Street No./police station, village and District (with PIN code)------------ --------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------
13. If you have not resided at the address given at COLUMN (10) continuously for the last five years, please furnish the other address (addresses) with duration(s) resided.
From …………….To.…………… Address ___________________________ _____________________________ ___________________________ ______________________________
14. In case of stay abroad particulars of all places where you have resided for more than one year after attaining the age of twenty-one years.
……………………………………………………………………………………………
15. Other Details:
(a) Educational Qualifications: ……………………………………………………..
(b) Previous posts held along with name and address of employer:……………… …………………………………………………………………………………………….
(c) Reason for leaving last employment:…………………… ………………………
(d)Visible Distinguishing Mark on body: …………………………………………………
(e) Height (cms):……………………………………….
(f)Affidavit incorporating the provisions of Section 10 (1) & (2) of the Act enclosed: Yes/ No
16. Are you working in Central Government/ State Govt/ PSU/ Statutory Bodies: Yes/ No
17. Are you a citizen of India by: Birth/Descent/Registration/Naturalisation: If you have ever possessed any other citizenship, please indicate previous citizenship………………………
18. Have you at any time been convicted by a court in India for any criminal offence & sentenced to imprisonment? If so, give name of the court, case number and offence. (Attach copy of judgment) ………………………………………………………………………
19. Is/Are any criminal proceeding(s) pending against you before a court in India? If so, give name of court, case number and offence ……………………………………………… ……………………………………………………………………………………………
20. Has any court issued a warrant or summons for appearance or warrant for arrest or an order prohibiting your departure from India? If so, give name of court, case number and offence.……………………………………………………………………………………… [भाग II—खण् ड 3(i)] भारत का राजपत्र : ऄसाधारण 35
21. Self Declaration:
The information given by me in this form and enclosures is true and I am solely responsible for accuracy.
22. Finger Prints:
(Signature of applicant) Date ………….
Place ………… Enclosures:
…………………………………………………………………………………………………… …………………………………………………………………………………………………… (Signature of applicant) Form-VI (See rule 7(2)) Affidavit I……………………………S/o / D/o / W/o Mr./Ms. ……………………..resident of …………………………….. (Residential Address) offer myself for employment as a private security guard/supervisor in the private security agency M/s………………………….….. (Name of firm/agency/company) at ……………………….(Address of firm/agency/company). I do hereby solemnly affirm and declare as under:
1. That I am a citizen of India.
2. That I have attained the age of 18 years but have not attained the age of 65 years. My date of birth is………………..
3. That I have not been convicted by a competent court.
4. That I have not been dismissed or removed on grounds of misconduct or moral turpitude while serving in any of the armed forces of the Union, State Police Organisations, Central or State Governments or in any private security agency.
Deponent Verification:- I,…………………………. hereby solemnly affirm on ………..(date) that the contents of above this affidavit are true and correct to the best of my knowledge and belief nothing has been concealed therein.
Deponent Note: The provisions of section 10(2) of the Private Security Agencies (Regulation) Act, 2005 (29 of 2005) may be printed at the back of affidavit for awareness of deponent as follows:
―Section 10. Eligibility to be a private security guard.
(2) No person who has been convicted by a competent court or who has been dismissed or removed on grounds of misconduct or moral turpitude while serving in any of the armed forces of the Union, State Police Organisations, Central or State Governments or in any private security agency shall be employed or engaged as a private security guard or a supervisor.‖ 36 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(i)] FORM VII (See rule 7(6)) CHARACTER AND ANTECEDENT CERTIFICATE (This certificate is issued under the provisions incorporated in the rules of the Private Security Agencies (Regulation) Act, 2005.)
This is to certify that Mr. /Ms. ………………….. , Son/Daughter of ------------------- whose particulars are given below has good moral character and reputation and that the applicant has been staying at the following address(es) continuously for the last one year ……… ……………………………………………………………………………………………………… Date of Birth Place of Birth Educational Qualification:
Profession:
Present Address Permanent Address This certificate is issued on the basis of …………………. (Source of certificate) and shall be valid upto a period of five years from its date of issue.
Issuing Authority Signature Name Designation Address/Tel.No.
Date of Issue FORM VIII (See rule 8(5)) Training Certificate Serial number Name of the Training Agency Address of the Training agency Training Agency Recognition No………… [The recognition of this agency is valid upto…………….(date)] Certified that ___________ son/daughter of _______resident of ______has completed the prescribed training for the engagement or employment as a Private Security Guard/Supervisor confirming to National Skill Qualification Framework (NSQF) standards from ___ till ____.
His signature is attested below.
Signature of the Certificate Holder Signature of issuing authority Designation Place of issue Date of issue [भाग II—खण् ड 3(i)] भारत का राजपत्र : ऄसाधारण 37 FORM IX (See rule 11) Form for Appeal An Appeal under section 14 of the Act Appellant _________________ S/o______________________ r/o______________ Versus Controlling authority/_____________ The _____________ above named appeal to the _______ (State Home Secretary) _________ from the order of (Controlling Authority) dated ____ day of________ and against refusal of licence to run Private Security Agency_______ and sets forth the following grounds of objection to the order appeal from namely __________
1. ________________
2. __________________
3. _________________
4. __________________ Enclosed list of documents ----------------------- Signature Name and Designation of the Appellant Date Place Form X (See rule 12) Register of Particulars (Register A: Management details) S.No. Name of person(s) managing the Agency Parent’s/ Father’s name Present address& phone no.
Permanent Address Nationality Date of joining/leaving the agency
1.
(Register B: Private Security Guards and Supervisor) Sl.
No.
Name of Guard/ Supervisor Father’s name Present address & phone no.
Date of Joining/ leaving the Agency Permanent Address Photograph Finger Prints Employee No.
Salary with date, ESI, EPF numbers and Bank/Branch through which paid.
1.
2.
38 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(i)] (Register C: Customers) Sl.No. Name of the Customer & phone no.
Address of the place where Security is provided Number and ranks of Security Guards provided Date of commencement of services Date of discontinuation of services (Register D: Duty Roster) S.No. Name of the Private Security Guard /Supervisor Address of the place of duty Whether provided with any arms/ammunition Date and time of commencement of duty Date and time of ending of duty Form XI (See rule 13) Photo Identity card for Private Security Guard/Supervisor (Name of the Private Security Agency) Identity Card No…………………..
Name ----------------------- Official Designation--------------------------------- Employee no. --------------------------- Blood Group__________________ Date of issue --------------- Valid up to ----------------------- Signature of the cardholder----------- Signature of the issuing authority Official seal [F. No. 24021/8/2019-PM-1] VIVEK BHARADWAJ, Addl. Secy.
Uploaded by Dte. of Printing at Government of India Press, Ring Road, Mayapuri, New Delhi-110064 and Published by the Controller of Publications, Delhi-110054.
Colour Photo MANOJ KUMAR VERMA Digitally signed by MANOJ KUMAR VERMA Date: 2020.12.18 21:48:59 +05'30'