(1) Notwithstanding whether the Agency mandates its private security guards to put on the uniform while on duty or not. every private security agency shail issue and make it obligatory for its security guards to put on:
(a) an arm badge distinguishmy the Agency;
(b) shoulder or chest badge to indicate his position in the organization;
(¢) whistle attached to the whistle cord and to be kept in the left pocket;
(d) shoes with cvelets and laces:
(e) a headgear which may also carry the distinguishing mark of the Agency.
(2) The clothes wor by the private security. guard while on active duty shall be such that they do nat hamper his efficient performance. in particular, they shall neither be too tight nor too loose to obstruct movement or bending of limbs.
(3) Every private security guard shall carry a notebook and a writing instrument with him.
(4) Bvery private security guard while on active security duty shall wear and display a photo-identity card issued under section {7 of the Act. on the outermast garment above waist level on his person ina conspicuous Manner.
By order of the Governor Sd/- (Nandini Chakravorty) Home Secretary & Principal Secretary te the Government of West Bengal Home & Hill Affairs Department 5 Paarl] THE KOLKATA GAZETTE, EXTRAORDINARY. MARCH 8, 2025 9 Form i (See rule 3, 3) APPLICATION FOR GRANT OF LICENCE /RENEWAL OF LICENCE TO ENGAGE IN THE BUSINESS OF PRIVATE SECURITY AGENCY To ‘The undersigned hereby applics for obtaining a licence to run the business of operating services in the area of Private Security Agencies
1. Fullname of the applicant:
2. Nationality of the applicant:
ory Son/wife/daughter of:
4. Residential Address:
§. 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. cccccssssesensseeesessseeneessnes (BD) ESL NO. ccesessesssseeseeeecsecesenteneeeeceesasessne
(c) EPF No.
(d) Labour Licence NO. wee ee {e) Labour Registration No. .
CR, GBT BGs sescnexnmmnensswnmsnncennwnmnmonsn mone
(2) Any other information, occ erences (h} Whether the Agency has FDI? (Yes’No}. eee IF Yes, Give the following information:
(i) Country of PDD 2 cei eect teenie Gi) Name of foreign Shareholder <a. ccc sss eee tetas
(ii) Address of foreign Sharcholder to .ecccccccccecceeecesesseeteeeeeseeeenense
(iv) Year of investment : .
(v) No. of shares oe ee
(vi) Percentage of foreign Shareholding 2.0.0... cece tec
(vil) Approval details of FOE 0 0. ee etter tin cis (Please attach the relevant document of FDI approx al} THE KOLKATA GAZETITI XTRAORDINARY, MARCH 8, 2025 a [Part !
8. Name and addresses of Proprietor, Partner, Majority shareholder. Director and Chairman of the Agency:
(Proprietor/partner/Majority Sharcholder/Director/Chairman) Management Type Name Address DIN No.
(if held) ID Proof with no.
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) ifthe applicant has own training facility, please provide the following information: , : Name of training agency:
Address of Training agency:
Recognition details of Training agency 2 oo eee rete Ii. 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 Gi} Wireless Telephones
(ii) Alarm Devices Gli} Armoured Vehicles
(iv) Arms
12. The particulars of the uniform including colour, (Please attach colour photo of uniforms).
13. Does the applicant intends to operate in more than one districts? If so the name of the Districts
1. Zi 3: Abe 5.
14. Docs the applicant intend to operate in the entire state? Yes / No Signature Name of the applicant *Address of the applicant ‘Telephone number of the applicant Date of application Enclosure:
[. Phote of the premises of the Agency.
2. 1D Proof of ail 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 Paya 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.
% Pant I] THEKOLKATA GAZETTE. EX FRAORDINARY, MARCH 8, 2025 i Korm It (See ruie 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 Appheant _ For official use only ‘Form number Antecedents verification issuéd by: : : . Date Fee Amount Rs.
D.D No.
_ Cash /D.D. Name of Bank Please fill in BLOCK LETTERS: (CALTION: 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 naine 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): on
4. Aadhaar No. ee
6. PANNo.
7. Place of Birth: Village / Town District State and Counuy . _
8. Father's Full Name/ Legal Guardian's Full Name (including surname. if any): (initials not allowed) 9, Mother's Full Name (including surname. i any): tnitials 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 (vith PIN code) —- _. lephone No/Mobile No. wt _- ’ ad 12 THE KOLKATA GAZETTE, EXTRAORDINARY, MARCH 8, 2025 [Parr]
12. Please give the date since residing at the above-mentioned address:
(DD/MM/Y YY Y}
13. Permanent Address including Street No. ‘police station. village and District (with PIN code)
14. Ifyou have not resided at the address given at COLUMN (11) continuously for the fast five years. please furnish the other address (addresses) with duration(s) resided.
From To Address
15. In case of stay abroad particulars of all places where you have resided for more than one year after attaining the age of Uwenty-one years.
16, Other Details:
(a) Educational Qualifications. :
(b) Previons positions held if any along with name and address of employers:
{cr Reason for leaving last employment:
(d} Visible Distinguishing Mark:
fe) Last 3 years FF Retum:
S.No. Assessment Year copy of ITR enclosed (Yes/No) I.
+ 3, (Affidavit incorporating the provisions of Section 6 of the Act enclased: 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 .0.0.0..0.ccececssecesecssseevsveesecceveeeegravel
18. Are vou a ertizen of India by: Birthy Desvenv/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
24. Self-Declaration:
The information given by me in this form and enclosures is true and Lam sulely responsible for accuracy, (Signature of applicant) ‘\. Paarl] THE KOLKATA GAZETTE. EXTRAORDINARY, MARCH 8 2025 13 senescence terseseense is a Proprietor? Partner! Director of Més Porm-IH (See rule 3(2)/ rude SQ) Affidavit Deo § Wie Mr Ms ABENCY/COMPANY) Al oe eee err (Address of firm/agency/company).
1 do hereby solemnly affirm and declare as under:
1. That the deponent is a citizen of India.
i) 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:
SE. Na. Name of the Proprietor/Partners/ Designations in the firny/ Residential Address Dircetors agency/company (Proprietor!
Partner/Direetor} f
4. That the deponent or any of the Proprictor’ Partner’ Director has not been convicted of any offence in connection
10.
with promotion. formation or management of a company (any fraud or misfeasance conunitted by him in relation to the firm/agency/company), including an undis harged insolvent.
That the deponent or any of the Proprietor’ Partner’ Direetor has not been convicted by a competent court for an offence, the prescribed punishment for which is imprisonment of not less than two years.
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.
That the deponent or any of the Proprietor Partner. Director has not been dismissed or removed Irom Government service on grounds of misconduct or moral turpitude.
That the firm/agency/company is registered m India and does not have a propricter or a majority shareholder, partner or director, who is nota citizen oF India, That the deponent and all the Partner? Director of the firm/agencs 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 ensunng availability/imparting of such training and skills to 11s private security guards and supervisors as prescribed.
That the deponent and all the Partner? Director of the fimmvagency-company shall fulfill the following conditions of licence as stipulated under section 11 of the Private Security Avencies (Regulation) Act, 2005 (29 of 2005).
(i) prescribed taining which the licensee ts to undergo:
(ii) details of the person er persons forming the agency.
14 THE KOLKATA GAZETTE, EXTRAORDINARY, MARCH 8, 2025 [Parl {ii} 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 Goverment 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.
11. That there are no cases registered with police or pending in court of Faw against the deponent.
Or That there are cases revistered 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 under the Act and also comply with the instructions issued from iime to ume by the Controlling Authority appointed under the Act, while managing private security agency with the name and tithe M/ Deponent .
Veritication®. ly ncaasnayyzeeneaene hereby’ soleninly Qt OB) weseessnorvaunrsensuenonoimeowesvaaee (date) that the contents of above this affidavil are true and correct to the best of my knowledge and belief nothing has been concealed therein.
Depanent Note: (i) Point No. 4 to 8 relates to compliance of section 6 of the Act
(i) Point No. Y relates to compliance of section 9(2) of the Act.
Gi) Point Ne. 10 and [1] relates ta compliance of section |] of the Act.
Gv} Strike the points which are not applicable.
Parr] THE KOLKATA GAZETTE, EXTRAORDINARY, MARCH 8, 2025 1S From IV (See rule 3(70)) GOVERNMENT OF Licence to engage in the business of Private Security Agency Serial No.
to mun the business of Private Security Agency in the distriet(s) of / State of (strike of the inapplicable words)- WHR OFTTCO at ccc ceccepeccesseetstesvaneteseeveeeees (address of the office} Name of granting authority Designation Official Address .
. RENEWAL (See rule 3(43) SL No Date of Renewal Date of expires Signature Name of renewing authority Designation Official Address 16 THE KOLKATAGAZETTE, EXTRAORDINARY, MARCH &, 2025 (Paarl Fora V (See rule 7{2)) Form for verification of Character and antecedents of Security Guard and Supervisor Signature of the Applicant... cscs rin 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 Hil 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 rm 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):
Aadhaar No.
we wn
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 summame, ifany): initials not allowed)
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 residimg at the above mentioned address: DD/MM/YYYY Part] THE KOLKATA GAZETTE, EX PRAORDINARY, MARCH 8, 2025 17
12. Permanent Address including Street No./ Police station’ Village and District (with PIN code) 4, hwfe) .(b} Previous posts held along with name and address of employer ¢ If vou have not resided at the address given at COLUMN (10) continuously for the last five years, lease furnish the other address (addresses) with duration(s) resided FYOM eee eeeeeeeeenteeees LU) scvoeeanaensnneenertes : Address In case of stay abroad particulars ofall places where you have resided for more than one year after atiaining the” age of twenty-one years. 00...
Other Details:
(a) Educational Qualifications :
(c) Reason for leaving last employment
(4) Visible Distinguishing (©) Height (cms):
(Affidavit incorporating the provisions of Section 10(1) & (2) of the Act enclosed Yes ¢ No Are you working in Central Government: State Govt! PSUY Statutory Bodies : Yes / No Are you a citizen of India by: Birth/Descent/Registration/Naturalisation: I you have ever possessed any other Citizenship, please indicate previous citizenship o.oo cscs essssseseessesecsssarsssedscosescesssevesesesteeeeecesssseseeceeceseeceeces 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) oo ee Is‘Are any criminal proceeding(s} pending against you before a court in India? ff so, give name of court. casey 2S) DP gas ’ g number and offence oo... cece eee ve ceretteteens 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 eee ccecccccccssscssceescssessssssesecsssesossees Self Declaration:
The information given by me in this form and crclosures is true and | an solely respousible for accuracy, Finger Prints:
(Signature of applicant) 18 THE KOLKATA GAZETTE, EXTRAORDINARY, MARCH 8, 2025 [Parr Form-VI (See rule 7(2)) Affidavit Slo § Dio / WO MilMS. ec ccseseeeseretecteeteeeeees resident of .... (Residential Address) offer myself for employment as a private security (Name of firm/puard/supervisor in the private security agency M/S...
agency/COMpany) Ato... eee eet (Address of firm/agency/company).
1 do hereby solemnly affirm and declare as under:
1. That | 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 DIU IS Co cee tenet eteetertetee
3. That | have not been convicted by a competent court.
4. That] 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 .. hereby solemnly affirm onVerification: 1, se os affidavit are true and correet to the best of my knowledge and belief nothing has beenthat the contents of above this 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:
Seetion 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.
> Parr I] THE KOLKATA GAZETTE. EXTRAORDINARY, MARCH 8, 2025 19 Form-Vil (See ruie 7664) CHARACTERAND ANTECEDENT CERTIFICATE (This certifieate is issued under the provisions incorporated in the rules of the Private Securily Agencies (Regulation) Act, 2005.)
This is to certify that Mr sMs. occ eee Bensananncensoen Son:Daughler Ob scvcsswnsvessassvevaiiitiessscoesenee 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 .c.ccccccccccssescescese cece eee (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 :
20 THE KOLKATA GAZETTE, EXTRAORDINARY, MARCH 8, 2025 [Parrl Form-VIE.
(See rule 8(35)) 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 Certified that . son/daughter of resident of __ has completed the prescribed training for ihe engagement or employment as a Private Security Guard/Supervisor confirming to National Skill Qualification Framework (NSQF) standards from ._—_-____ _ ti} His signature is attested below, Signature of the Certificate Holder Signature of issuing authority Designation Place of issue Date of issue Part] THE KOLKATA GAZETTE, EXTRAORDINARY, MARCH 8, 2025 21 Form-IX ‘Swe rale if Forn: for Appeal An Appeal under section 14 of the Act Appellant__ S/o vo 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 groundsof objection to the order appeal from namely Signature Namne and Designation of the Appellant Date Place a 22, THE KOLKATAGAZETTE, EXTRAORDINARY, MARCH 8, 2025 {Part I Form X (See rule 12} Register of Particulars (Register A: Management details) mo 7 [ ~ eeraewayl .
SL | Nameof | Parent's! i Present address | Permanent Nationality Date of No. person(s) | Father's name & phone no. Address joining/leaving managing the agency the Agency J (Register B: Private Security Guards and Supervisor) SL. Name of | Father's name} Present Date of |Permanent| Photograph | Finger Employee] Salary with No. Guard/ address | Joining’ | Address Prints No |date, ESI, EPF Supervisor & leaving numbers and phone no. | the Agence Bank/Branch through which paid t.
Os Lowen (Register C: Customers) SL. Name of the Address of Number and Date of Date of “No. Customer & the place where ranks of commencement | discontinuation phone no. Security is Security Guards} of services of services provided provided .
(Register D: Duty Roster) SL Name of the Address of the | Whether provided] Date and time Date and time No, Private Security place of duty with any arms/ of of ending Guard / Supervisor ammunition commencement of duty of duty Parti] Photo Identity card for Private Security Guard/Supervisor (Name of the Private Security Agency) Wdentity Card NO. wees.
i Colour Photo Name Employee no.
Blood Group oo Date of issue... ;
Valid Up 10 ce .
Signature of the cardholder a Signature of the issuing authority Official sea] By order of the Governor.
Sd (Nandini Chakravorty) Home Secreta ry & Principal Secretary to the Go vernineat af West Bengal Home & Hill Affairs Department mment of West Be; Hone and Hill Affans I Saraswaty Press Ltd. (Goverment af West Bengal iaterpris ania and printed at Published b v Gay purinent, Inte 2). Kolkata 700 056,