Private Security Industry

Regulatory Authority (SIRA)

THE DIRECTOR
PRIVATE SECURITY INDUSTRY Application for registration as a security service
REGULATORY AUTHORITY provider in terms of the Private Security Industry
PRIVATE BAG X817 Regulation Act 56 of 2001 (“the Act”)
PRETORIA
0001 APPLICATION FOR RENEWAL OF
BUSINESS CERTIFICATE

APPLICATION FOR:
01 RENEWAL 02 REISSUE

0 7
/ 0 5
/ 2 0 2 2
/ Application Date (dd/mm/yyyy)

PARTICULARS OF THE BUSINESS

Business Name

PSiRA Number

Size of Business (Please tick)

SMALL MEDIUM LARGE
(Turnover of 0- (Turnover of R5-35 Million (Turnover of above 35 Million a
R15Million rand a year) rand a year) year)

SA Ownership: _____________% Foreign Ownership: __________________ %

BEE Level (Please tick)

BLACK OWNED WHITE OWNED

Note: If the Business address has changed, a change of address fee must be paid before a new certificate is printed.

PHYSICAL ADDRESS OF THE BUSINESS

Postal Code

POSTAL ADDRESS (if different to Physical Address)

Postal Code

TELEPHONE NUMBERS (Code/Number)

Business Fax Cellphone

Email address: ___________________________________________________________________

I the undersigned,______________________________________________________________________________________
Full name and identity number

declares that the information furnished on this form is true and complete to the best of my knowledge. I agree that Private Security Industry
Regulatory Authority may summarily approve\rejects my application in case any of the information/record(s) furnished above found to be
incorrect or false and I will not make any correspondence in the matter whatsoever and I will abide by the decision of the Private Security
Industry regulatory Authority.

Page 1 of 3 Pages
THUS DONE AND SIGNED at on Of 20__________

SIGNATURE:

FOR OFFICE USE ONLY

1. Purpose of the visit collection of new certificate/ re issue/upgrade
2. Confirmation of business registration with PSIRA YES/NO
3. Confirmation of Members, Directors or Owners’ registration with PSIRA YES/NO
4. Confirmation of business registration with CIPC YES/NO
5. Confirmation of Member, Directors, owner registration with CIPC YES/NO
6. PSIRA fees paid in full YES/NO
7. Submission of original valid Tax clearance certificate YES/NO
8. Proof Old certificate/affidavit in case of loss, theft etc YES/NO
9. Total amount to be paid R

I have confirmed the above to be correct

Name of PSIRA official--------------------------------
Signature-------------------------------------------------
Date ------------------------------------------------------

Page 2 of 3 Pages
 Security Industry Regulatory Authority
Renewal of certificate Checklist - Business
Business name

Date

REQUIREMENT

1. Application letter from business (printed on business letterhead)

2. Original valid tax clearance certificate o

nd rd
3. Payment of prescribed amount (R250.00 First issue / R500.00 2 issue and R1500 3 issue)

4. Proof of old certificate or Affidavit in case of a loss, theft etc

5. Annual fees paid in full

Page 3 of 3 Pages