Microsoft Word - the Haryana Private Security Regulation Rules 2009 Engli 205

Form1

(seerule4)

Formforverificationof antecedentsofapplicant

1.Thumbimpressionof theapplicant:(PleaseaffixleftHandThumb impression incaseofMaleandRight Hand Thumb Impression in case of

Female)

2.SpecimenSignatureof theapplicant:(i)……………………………(ii)…………………………....(iii) ………………………..…..

Passportsizerecent photographattested byclass-1

GazettedOfficer

Please fillall particularsin BLOCK LETTERS. (CAUTION: Please furnish correctinformation. Suppressionofany factual informationshall renderthecandidateunsuitable forgrantof license.)

3.Paymentoffeedetails:

FeeAmount…………………Modeof Payment……………………………

Nameof Bank(if any)………………No.date………………………….

PersonalParticulars:-

1.Lastname: …………………………………………….……….

2.Firstname:…………………………………………….…..……

3.Iftheapplicanthaschangedhisname,pleaseindicateallpreviousnamesinfull: ………………………………………………………

……………………………………………….………

4.Sex(male/female):………………………….…….

5.Dateof birth:………………Age:…………………………

6.Placeof Birth:…………………..……………….

District, StateCountry:…………………………………..

7.VisibleDistinguishingMark:………………………………….

8.TelephoneNo(withSTDcode):………………………………….

9.FAXNo:…………………………………

10.CellPhoneNo:…………………………………

11.ParticularsoffamilyMembers:

12.PresentResidentialAddress:

13.Pleasegive datesinceresidingattheabove-mentionedaddress: ……………..

14.Iftheapplicanthasnotresidedattheaddressgivenatcolumn(12)abovecontinuouslyforthelast fiveyear,particularsof earlieraddresses:

Pleasefurnishadditional copiesofthisformforeachadditional placeofstayduring the last five year. Forms may be photocopied if required, butphotographandsignaturearerequiredtobeaffixedinoriginaloneachcopy.

15.PermanentAddress:

16.In case ofstayabroad,particularsofplaceswheretheapplicanthasresidedfor

morethan6monthsafterattainingtheageof twenty-oneyears:

17.OtherDetails:

(a) Educational Qualifications:

(b) Workexperience:

(c) Reasonforleavinglastemployment:………………………………….

18.HaveyoueveroperatedanyPrivateSecurityAgency:……………………

19.Ifyes,give details:

S.No.NameaddressSincewhen

20.Areyouacitizenof India?Yes/No

Ifyes, whether byDescent/Registration /Naturalization (Please tick thecorrect option)

21.Incaseyouhaveeverpossessedcitizenshipof anyothercountry,give names:

…………………………………………………………………………………

22.HaveyouatanytimebeenconvictedbyacourtinIndiaforanycriminaloffence? Ifyes,givedetails(Casenumberyear,PoliceStation,Nameofthe courtandoffence):

…………………………………………………………………………………

…………………………………………………………………………………

(Pleaseattachcopyof thejudgementineachcase)

23.Areanycriminalproceedingspendingagainst youbeforeacourtin India?

Ifyes,givedetails(PoliceStation,Casenumberyear,Nameofthecourtandoffence):……………………………………………………………………

…………………………………………………………………………………

Date Place

(Signature/T.Iof applicant)

24.Enclosures:

1.…………………………………..

2.…………………………………..

3.…………………………………..

4.…………………………………..

Declaration:TheInformationgivenbymeinthisfromandenclosuresistrueandI

amsolelyresponsibleforitsaccuracy.

(Signature/T.Iof applicant)

(*PleaseaffixleftHandThumbimpressionincaseofMaleandRightHandThumbImpressionin caseofFemale)

Forofficeuseonly

FORMII

(seerule5)

Formforverificationofcharacterandantecedents for PrivateSecurityGuard

1.Thumbimpressionof theapplicant:(PleaseaffixleftHandThumb impression incaseofMaleandRight Hand Thumb Impression in case of

Female)

2.SpecimenSignatureof theapplicant:(i)……………………………(ii)…………………………....

(iii)………………………..…..

Passportsizerecent photographattested byclass-1

GazettedOfficer

Please fillall particularsin BLOCK LETTERS. (CAUTION: Please furnish correctinformation. Suppressionofany factual informationwillrenderthecandidateunsuitable forgrantof license.)

3.Paymentoffeedetails:

FeeAmount…………………Modeof Payment……………………………Name of Bank(ifany)………………No.date………………………….

PersonalParticulars:-

4.Lastname: …………………………………………….……….

5.Firstname:…………………………………………….…..……

6.Iftheapplicanthaschangedhisname,pleaseindicateallpreviousnamesinfull: ………………………………………………….………

………………………………………………….………

11.Height:…………Weight:…………Chestwithoutexpansion…………

withexpansion………………...(applicableincaseofmaleapplicantsonly)

12.TelephoneNo(withSTDcode):………………………………….

MobilePhoneNo:…………………………………

13.(i)PassportNo:………….Date:………… Issuedat:………..(ii)VoterIDCardNo:………………. Issuedby:……………….(iii) Name/Particularsof anyotherID proof: ……………………..

Number:………….Date:………Issuing authority:……….

14.ParticularsoffamilyMembers:

15.PresentResidentialAddress:

16.Pleasegive datesinceresidingattheabove-mentionedaddress: ……………..

17.Iftheapplicanthasnotresidedattheaddressgivenatcolumn(12)above

continuouslyforthelastfiveyear,particularsof earlieraddresses:

Pleasefurnishadditionalcopiesofthisformforeachadditional placeofstayduringthelastfiveyear.Formsmaybephotocopied ifrequired,butphotographand signaturearerequiredtobeaffixedinoriginaloneachcopy.

18.PermanentAddress:

District:State:PINCode:

19.Incaseofstayinaforeigncountry,particularsofplaceswheretheapplicant

hasresidedformorethan6monthsafterattainingtheage of twenty-oneyears:

20.OtherDetails:

(a) Educational Qualifications:

(b) Workexperience:

(c) Reasonforleavinglastemployment:………………………………….

21.DoyouhaveavalidCharacterand antecedentscertificatein Form III? Yes/No

Ifyes,pleaseattachacopy.

22.Areyouacitizenof India?Yes/No

Ifyes, whether byDescent/Registration /Naturalization (Please tick thecorrect option)

23.Incaseyouhaveeverpossessedcitizenshipof anyothercountry,give names:

…………………………………………………………………………………

24.HaveyouatanytimebeenconvictedbyacourtinIndiaforanycriminaloffence? Ifyes,givedetails(Casenumberyear,PoliceStation,Nameofthe courtandoffence):

…………………………………………………………………………………

…………………………………………………………………………………

(Pleaseattachcopyof thejudgementineachcase)

25.Areanycriminalproceedingspendingagainst youbeforeacourtin India?

Ifyes,givedetails(PoliceStation,Casenumberyear,Nameofthecourtandoffence):……………………………………………………………………

…………………………………………………………………………………..

26.HasanycourtissuedawarrantorsummonsforappearanceorwarrantforarrestoranorderprohibitingyourdeparturefromIndia?Ifsogivenameofthe Court,casenumberandotherdetails.

…………………………………………………………………………………

………………………………………………………………………….

27.Declaration:

Theinformation givenbymeinthisformandenclosureistrueandIamsolelyresponsible for accuracy.

(Signature/T.Iof applicant)

(*Left HandThumbImpressionifMaleandRightHandThumbImpressionif

Female) Date………………….

Place………………….

28.Particularsof personto beintimatedintheeventof deathoraccident: Name………………………………………………………………………… Address…………………………………………………………………….. Mobile/Tel. No……………………………………………………………

29.Enclosures:

1.………………………………..

2.………………………………..

3.………………………………..

4.………………………………..

(Signature/T.Iof applicant)

(*PleaseaffixleftHandThumbimpressionincaseofMaleandRightHandThumb

Impressionincase of Female)

FORMIII

[Seerule5(10)]

CHARACTERANDANTECEDENT CERTIFICATE

ThisistocertifythatSh/Smt/Km……………………………………………………..Son/Daughter of………………………………………………………………………. whoseparticularsaregivenbelowhasgoodmoralcharacterandreputationandthat theapplicanthasbeenstayingatthefollowingaddress continuouslyforthelast

…………. :-

Dateof Birth…………………………………………………....Place ofBirth……………………………………………….….. EducationalQualification………………………………….…… Profession:………………………………………………….…… Present Address…………………………………………………. PermanentAddress………………………………………………

IssuingAuthority

Signature:

NameDesignation:…………………… Address/Tel No: ……………………

Dateof Issue:…………………….

FORMIV

[Seerule6(4)]

TrainingCertificate

Serialnumber:………………

Nameof theTrainingInstitution:……………………………………………...Address oftheTrainingInstitution: …………………………………………….

…………………………………………….License No: ……………………

CertifiedthatSh/Smt/Km……………………………………………………………Son/daughter of…………………………………………………………………….. Resident of…………………………………………………………………………..

hascompletedtheprescribedtrainingfortheengagementor employmentasaPrivate

SecurityGuardfrom………………To …………………His signatureis attestedbelow:

Signatureof theCertificateHolder:

……………………………………

Placeof Issue………………….Date ofIssue…………………..

Signatureof issuingauthority

Designation:

FORMV

(SeeRule9and11)

APPLICATIONFORLICENCE/RENEWAL

To

TheControllingAuthority

…………………………..

………………………….

Theundersigned herebyapplies for obtaining a licence to run the

businessof PrivateSecurityAgency:-

1.Nameof theApplicant:.……………………………………......

2.Address:……………………………………………………………

……………………………………………………………………

…………………………………………………………………….

3.TelephoneNo:……………………Fax No:…………….

Emailaddress:…………………...

4.Addresswheretheapplicanthasordesirestohavehisprincipalplaceofbusiness: ………………………………………………………….

……………………………………………………………………….

5.Nameaddressandcontactdetailsof theauthorizedrepresentativeof theapplicant for the purposeofcorrespondence withtheControlling Authority………………………………………………………………

…………………………………………………………………………

6.NamesandAddressesofProprietor,Partners,Shareholders,Managing

Director,Directorsandimportantofficebearersof theAgency:

(Please attach separate sheet if required. Also furnish personal

particularsof each of the personsabove in FormI separatelyforverification ofantecedents.)

7.Particularsof facilitiesavailable…………………………(Please attach separatesheetifrequired)

8.Qualificationsof staffengagedforimpartinginstruction;Name …………………………………………………… Age…………………………………………………….. Designation……………………………………………. (Please attach separatesheetsifrequired)

9.EquipmentavailableforprovidingSecurityservices:(Please attach separatesheetifrequired)

10.Particularsof uniform(color,badgeetc):(Please attachseparatesheetifrequired)

11.DoestheapplicanthavelicencetooperateprivatesecurityagencyinanyotherState?……… (Ifyes,enclose copyof thelicence)

12.Doestheapplicantintendtooperatein morethanonedistrict/ifsoname of theDistricts

1………....….2…………..…3………..……4……..…..….5……..……(Please attach separatesheetifrequired)

13.Doestheapplicantintendtooperateintheentirestate:

14.DoestheAgencypossesstrainingfacilityofitsownorwillitgetitonoutsourcing basis? ……………………………………………………..The name and address of each such training facilities should befurnished inaseparatesheet,ifrequired).

15.Paymentoffeedetails:

Amount: ……………Modeof Payment:………………… Name of Bank(if any)………………No.date: ………….

Date: Place:

Signature:

Nameof theapplicant:

Addressof theapplicant:…………..

Enclosures:

1.Copyof currentIncometaxclearancecertificate.

2.Affidavitasprescribedinsection7(2)of the Act.

3.………………………..

4.………………………..

FORMVI

(Seerule11)

Licenceto engagein thebusinessofPrivateSecurityAgency

1.SerialNo…………………………..

2.Date……………………………….

3.Shri/Smt/Km…………………………………..(Nameoftheapplicant) son/daughter of …………………………………………………………….. R/O……………………………………………………………………………...

.…………………………………………………………….…….(FullAddress)

…………………..isherebygrantedthelicencebytheControllingOfficerfor the State of ……………………………………………………. to run the businessofPrivateSecurityAgencyintheDistrict(s)/Stateof(Strikeoff inapplicablewords)……………………………………….……………………

…………………………………………………………………..……………..

...…………………………………………………………...... ……………..with office at……………………………

Placeof issue……………………….…..Date ofIssue……………………………This Licenceisvalidupto………………

Signature

Nameof ControllingAuthority

Designation: Officials Address:

RENEWAL(Seerule-14)

1.

2.

3.

4.

DateofRenewalDateofExpiry

Signature

Nameof grantingAuthority

Designation

OfficialsAddress

FORMVII

(seerule13)

FormforAppeal

To

TheFinancialCommissionerandPrincipalSecretaryto

GovernmentHaryana, HomeDepartment, Chandigarh.

Sir/Madam,

Theundersignedherebyprefers an appeal under section14 of the

PrivateSecurityAgencies(Regulation)Act,2005asperthefollowingdetails:-

Shri/Smt/Km…………………………………..(Nameoftheapplicant)son/daughterof …………………………………………………………R/O ………….………..

………………………………………………………………………..(FullAddress)ControllingAuthority ………………………………………………………..AgainstOrderNoDate:………………………………….…………………..

Inthematterof:…………………………………………………………(Enclose copyof theimpugnedorder)

Ground(s)ofappeal:

…………………………………………………………………………………………

…………………………………………………………………………………………

…………………………………………………………………………………………(Enclose separatesheetifrequired)

Listsof enclosures:

1………………………………………

2……………………………………….

3………………………………………

4……………………………………..Signature

Nameof theappellant:………………...

Date………………….

Place………………….

FORMVIII

(Seerule14)

Register of particulars

(Part-IManagementDetails)

(Part-IIPrivateSecurityGuardsandSupervisors)

(PART-IIICustomerdetails)

(PART-IVDutyRoster)

FORMIX

(seerule15)

(Nameandlogoof thePrivateSecurityAgency)

1.Name…………………………………

2.Rank……………………………

3.IDNo…………………………………

4.BloodGroup………………………..

5.Validupto……………………………

6.Specimensignature:………………..

Photographof the holder dulyattested bytheissuing authority

Signatureof the

Dateof Issue:IssuingAuthoritywithOfficeseal

(Additionalinformationnamely,contactdetailsetcoftheAgencymaybe providedontheback side)

KRISHNAMOHAN,

FinancialCommissionerandPrincipalSecretaryto

Governments,Haryana,HomeDepartment.