Northern Territory Consolidated Regulations Northern Territory Consolidated RegulationsSCHEDULE
NORTHERN TERRITORY OF AUSTRALIA
Private Security Act
Private Security (Security Firms) Regulations
Regulation 3
Important : Please print in block letters. If there is insufficient space, attach extra sheets.
All questions must be answered and full particulars provided.
Application is made for a security firm's licence in one of the following capacities.
| 1. |
Natural person as a sole trader | |
| 2. | Natural persons in partnership | |
3. | Corporation |
Application is sought for: 1yr 2yrs 3yrs
(Please ensure both Part A and Part B of this application are completed before the application is lodged.)
PART A. Declaration of Applicant
| 1. NAME OF APPLICANT(S) | |||
| 2. WHERE THE APPLICANT IS A CORPORATION | |||
| a) A C N (Australian Company Number): | |||
| b) Date and place of incorporation: | |||
| c) Registered office address (if different from principal business address): | |||
TBC OFFICE USE ONLY | |||
| All sections of form completed. | Receipt number: | | |
Application signed by at least two directors & Part B certified by NT Police. | Amount paid: | | |
| Copy of Business or Company extract. | Date receipted: | | |
| Copy of Identification attached. | Additional comments: | | |
| Criminal History from NT Police attached. | | ||
RGL OFFICE USE ONLY
Actioning Officer: Date: / / Actioning Officer: Date: / /
3. WHERE THE APPLICANT(S) IS/ARE NATURAL PERSON(S) OR A PARTNERSHIP |
| Where the applicant is a natural person, he or she must provide the following information: |
| Where the applicant is a partnership, each partner in the partnership must provide the following information (by attached sheet where necessary): |
| Full name of applicant or each partner: |
| Date of birth: Place of birth: |
| Current residential address: |
| Full name: |
| Date of birth: Place of birth: |
| Current residential address: |
| 4. DETAILS IN RESPECT OF EACH DIRECTOR OR OTHER PERSON CONCERNED IN THE MANAGEMENT OF THE CORPORATION |
Where the applicant is a corporation, all directors, secretaries or executive officers of the corporation and all persons who control or substantially influence the conduct of the corporation's affairs, must provide the following information (by attached sheet where necessary). |
| Full name: |
| Date of birth: Place of birth: |
| Position held: |
| Current residential address: |
|
Full name: |
| Date of birth: Place of birth: |
| Position held: |
| Current residential address: |
| 5. PRINCIPAL BUSINESS ADDRESS |
| Telephone No: Fax No: |
| E-mail Address: |
| Business Trading Name(s): |
| Date business name(s) registered: |
| Address for service of notices: |
| DECLARATION | |
|
I/We hereby declare that to the best of my/our knowledge the particulars furnished for the purpose of obtaining a licence under the Private Security Act are true and correct in every detail. (To be signed by the applicant, or, where the applicant is a corporation, no less than two directors or, where the applicant is a partnership, each partner). | |
| Signature | Signature |
|
Full Name | Full Name |
| Capacity | Capacity |
| Date | Date |