Application for a Company Licence

Private Security Personnel Licensing Authority For more information visit www.pspla.govt.nz Application for a Company Licence Under the Private Security Personnel and Private Investigators Act 2010 1 What is this form for? Use this form to apply for a company licence to run a business in the private security industry, as defined in the Private Security Personnel and Private Investigators Act 2010. 2 What do you need to complete your application? To complete your application you need to send: A fully completed form A cheque for $725 3 Please send a completed company officer form for every additional officer of the company to: Private Security Personnel Licensing Authority SX 10042 Wellington 4 Completing this form Print clearly in CAPITALS. Use a black or blue pen to complete this form. Answer every question on the form unless the instructions tell you otherwise. 5 Payment Information The fee for filing an application for a Company licence is $725. You can only pay by cheque. Make your cheque payable to: The Private Security Personnel Licensing Authority. For a quicker, easier, cheaper way of applying see www.pspla.govt.nz. Application fees are non-refundable. 6 How long will it take to hear the outcome of your application? In normal circumstances it will take 2 months to hear the outcome of your application. If the company has any convictions or any of the company officers have a criminal conviction your application may take longer to process. You can check the progress of your application on www.pspla.govt.nz 7 Important information If you, or your company: Provide false or misleading information to the Licensing Authority, you may be liable for a fine of up to $20,000. Work as a licensee and do not hold a licence you could be fined up to $60,000. All personal information provided to the PSPLA will be dealt with in accordance with the Privacy Act 1993. Page 1 For more information visit www.pspla.govt.nz PSPLA 02/15 - D

Z Section 1 Application details Class(es) of licence Specify the particular class or classes of business that you propose to work in: (you may tick Private investigator Security consultant Confidential document destruction agent Property guard Security technician Crowd controller Personal guard Repossession agent Section 2 Company Details What is the name of your company? Company registered name Company registration number more than one) Please advise the email address of every officer of the company below A company officer is a Director, CEO or person occupying an equivalent position. The amount of email addresses provided must match the number of officers of the company. If the company has previously held or currently holds a licence under the Private Investigators and Security Guards Act 1974 or Private Security Personnel and Private Investigators Act 2010, add the licence number below: Licence number Please describe the nature of all other business carried out or proposed to be carried out by the company Please provide the contact details of the person the Licensing Authority can contact regarding this application: First name(s) Middles name(s) Last name(s) Daytime contact number ( ) Home phone ( ) Mobile number Fax number ( ) Email address Page 2 For more information visit www.pspla.govt.nz PSPLA 02/15 - D

Section 3 - Address details What is the company s registered office address? Street Does the company have a separate postal address? (Please tick to confirm ) If yes what is your postal address: Street / PO Box Places of business Do you have any additional places of business (other than the registered office address already supplied)? (Please tick to confirm ) If yes please supply details, if no move on to section 4 Additional place of business 1 Street Additional place of business 2 Street Additional place of business 3 Street If you need to add any further additional places of business please attach a separate sheet to this application. Page 3 For more information visit www.pspla.govt.nz PSPLA 02/15 - D

Section 4 Company Disqualification Criteria relating to convictions Section 63 of the Private Security Personnel and Private Investigators Act 2010 sets out the grounds of disqualification for a company licence applicant. If the company meets any of the grounds of disqualification listed below, you will be able to make a statement about the circumstances or background of the company. The Licensing Authority may still grant your application, but only if the Authority is satisfied that the company is suitable to operate as a licensee in the class or classes of work to which the application relates. Please note that no refund is payable if your application is unsuccessful. You can find more information at www.pspla.govt.nz Has the company ever been convicted of an offence? (Please tick to confirm ) If yes, answer each individual question below (Please tick to confirm ), if no skip to section 5. In the last 7 years, has the company ever been convicted by a New Zealand court of an offence under sections 10, 11, 13, 16, 19, 21, 24, 47F, or 47J of the Fair Trading Act 1986? In the last 7 years, has the company ever been convicted by a New Zealand court of an offence under section 103(1) of the Credit Contracts and Consumer Finance Act 2003 that involves a breach of any provision of Part 3A of that Act? In the last 7 years, has the company ever been convicted by a New Zealand court of an offence under section 6 of the Misuse of Drugs Act 1975 in relation to quantities deemed for supply of a Class A, B or C controlled drug or drugs? In the last 7 years, has the company ever been convicted by a New Zealand court of an offence of dishonesty, as defined in section 4 of the Private Security Personnel and Private Investigators Act 2010 ( offence of dishonesty )? In the last 7 years, has the company ever been convicted by a New Zealand court of an offence under sections 16, 34 or 52 of the Private Investigators and Security Guards Act 1974? In the last 7 years, has the company ever been convicted by a New Zealand court of an offence under the Private Security Personnel and Private Investigators Act 2010 of operating while unlicensed or employing or engaging a person without a certificate of approval? Does the company currently hold a licence that is suspended? In the last 7 years has the company had a licence cancelled under the Private Security Personnel and Private Investigators Act 2010, or the Private Investigators and Security Guards Act 1974? Has the company ever been convicted outside of New Zealand of an offence? If you have answered yes to a ground for disqualification you can provide further information to support your application (for example, evidence of character of the company officers, circumstances, or background). If you need extra space please attach a separate sheet to this application. Page 4 For more information visit www.pspla.govt.nz PSPLA 02/15 - D

Section 5 Consent and Certification on behalf of the Company I consent on behalf of the company to the Ministry of Justice undertaking a check on any offences the company has been convicted of, using the information contained in this application. I certify that the above particulars are true and correct. Name Date / / (day / month / year) Signature Z Section 6 Company Officer details If you have more than one company officer please use the Company officer form for each additional company officer. What is your name? First name(s) Middles name(s) Last name(s) If you have previously held or currently hold a certificate of approval or licence under the Private Investigators and Security Guards Act 1974 or Private Security Personnel and Private Investigators Act 2010, add your licence or certificate number below: Licence or certificate of approval number Date of Birth / / (day / month / year) What is your gender? (Please tick to ) Male Female What is your occupation? Occupation Are you known by, or have you ever been known by another name? (Please tick to confirm ) If yes please supply details, if no leave this box blank and move on to the next question. Other name 1 First name(s) Middle name(s) Last name(s) Other name 2 First name(s) Middle name(s) Last name(s) Page 5 For more information visit www.pspla.govt.nz PSPLA 02/15 - D

Section 6 Company Officer details (contd) What is your residential address? Street Do you have a different postal address? (Please tick to confirm ) If yes what is your postal address: Street / PO Box How can we contact you? Daytime contact number ( ) Other contact number ( ) Mobile number Fax number ( ) Email address Z Section 6A Company Officer Identification Details Please provide details of your passport or New Zealand Drivers licence below. Passport number Nationality as shown on passport Passport expiry date / / (day / month / year) Date issued / / (day / month / year) or New Zealand Driver s Licence number Driver s Licence expiry date / / (day / month / year) Driver s Licence version number Page 6 For more information visit www.pspla.govt.nz PSPLA 02/15 - D

Section 6B Company Officer Disqualification Criteria Section 62 of the Act sets out the grounds for disqualification of a company officer. Disqualification of a company officer may cause disqualification of the company. If you meet any of the grounds of disqualification listed below, you will be able to make a statement about your character, circumstances or background. The Licensing Authority may still grant the company application, but only if the Authority is satisfied that you are suitable to operate as an officer of a licensee in the class or classes of work to which the application relates. Please note that no refund is payable if your application is unsuccessful. You can find more information at www.pspla.govt.nz Please answer each individual question below. (Please tick to confirm ) Have you ever been convicted of a specified offence as defined in section 4 of the Criminal Records (Clean Slate) Act 2004? In the last 7 years, have you been convicted by a New Zealand court of an offence under the Arms Act 1983? In the last 7 years, have you been convicted by a New Zealand court of an offence under sections 216H to 216J of the Crimes Act 1961? In the last 7 years, have you ever been convicted by a New Zealand court of an offence under sections 10, 11, 13, 16, 19, 21, 24, 47F, or 47J of the Fair Trading Act 1986? In the last 7 years, have you ever been convicted by a New Zealand court of an offence under section 103(1) of the Credit Contracts and Consumer Finance Act 2003 that involves a breach of any provision of Part 3A of that Act? In the last 7 years, have you ever been convicted by a New Zealand court of an offence under section 8 or 25 of the Harassment Act 1997? In the last 7 years, have you ever been convicted by a New Zealand court of an offence under section 6 of the Misuse of Drugs Act 1975 in relation to quantities deemed for supply of a Class A, B or C controlled drug or drugs? In the last 7 years, have you ever been convicted by a New Zealand court of an offence of dishonesty, as defined in section 4 of the Private Security Personnel and Private Investigators Act 2010 ( offence of dishonesty )? In the last 7 years, have you ever been convicted by a New Zealand court of an offence of violence, as defined in section 4 of the Private Security Personnel and Private Investigators Act 2010 ( offence of violence )? In the last 7 years, have you ever been convicted by a New Zealand court of an offence under sections 16, 34 or 52 of the Private Investigators and Security Guards Act 1974? Have you ever been disqualified from driving for an indefinite period and ordered to attend an assessment centre under section 65 of the Land Transport Act 1998, or an earlier equivalent provision? Have you ever been ordered by a court to be imprisoned following conviction for an offence and that conviction or order has not been quashed on appeal? In the last 7 years, have you ever been convicted by a New Zealand court of an offence under the Private Security Personnel and Private Investigators Act 2010 or Private Investigators and Security Guards Act 1974 for working without a licence or certificate or approval or employing or engaging a person without a certificate of approval? In the last 7 years, have you had a licence or certificate of approval cancelled under the Private Security Personnel and Private Investigators Act 2010 or the Private Investigators and Security Guards Act 1974? Do you hold a licence or certificate of approval that has been suspended? Page 7 For more information visit www.pspla.govt.nz PSPLA 02/15 - D

Section 6B Company Officer Disqualification Criteria (contd) (Please tick to confirm ) Have you ever had an order made in relation to you under section 34(1)(b) of the Criminal Procedure (Mentally Impaired Persons) Act 2003, section 118 of the Criminal Justice Act 1985, or section 39J of the Criminal Justice Act 1954 (being an order imposed, instead of passing sentence, that you be treated or cared for in a manner that your mental impairment requires, either in your own interest, or the safety of the public, or for the safety of the public, or for the safety or a person or class of person)? Are you currently subject to a court order that requires you to be detained in a hospital because of a mental condition? If you have answered yes to a ground for disqualification you can provide further information to support your application (for example, evidence of your character, circumstances, or background). If you need extra space please attach a separate sheet to this application. Have you met any requirements prescribed in regulations made under section 114(h)(i) of the Private Security Personnel and Private Investigators Act 2010, (which relate to the competency, knowledge, and skills required for licences and certificates of approval)? [You must provide proof of meeting those requirements with this application.] Have you within the past 5 years, had 12 months relevant experience as a licensee or responsible employee in the class or classes of private security business to which the application relates? [You must provide proof of meeting those requirements with this application.] If you have completed any of the training requirements set out in section 114(1)(h) of the Private Security Personnel and Private Investigators Act 2010 or have completed 12 months of relevant experience as a licensee or responsible employee in the last 5 years, please provide details below: If you need extra space please attach a separate sheet to this application. Page 8 For more information visit www.pspla.govt.nz PSPLA 02/15 - D

Section 6C Company Officer Overseas Mental Health Orders and Convictions (Please tick to confirm ) Section 25 of the Private Security Personnel and Private Investigators Act 2010 also requires that you specify if you have had an overseas mental health order or conviction. You may provide further information to support your application (for example, information about your character, circumstances, or background) if you have specified a conviction or order as follows: Have you ever had an order imposed in relation to you by any court or tribunal outside of New Zealand, instead of passing sentence, that you be treated or cared for in relation to your mental impairment? Have you ever been convicted of an offence outside of New Zealand? Please provide further information below: If you need extra space please attach a separate sheet to this application. Z Section 6D Company Officer Consent and Certification I consent to the Ministry of Justice undertaking a criminal history check using the information contained in my application. I certify that the above particulars are true and correct. Name Date / / (day / month / year) Signature Z Section 7 Checklist Before you submit this form please check that: (Please tick to confirm ) You have answered every relevant question; You have signed and dated this form; You have included a cheque for $725; and You have included a completed Company Officer form for every officer of the company, additional to the one named in this application. Please mail this completed form with cheque to: Private Security Personnel Licensing Authority DX Box: SX 10042 Wellington Page 9 For more information visit www.pspla.govt.nz PSPLA 02/15 - D

Legislative extract definitions of classes of business Meaning of private investigator (1) In this Act, private investigator means a person who, for valuable consideration, either by himself or herself or in partnership with any other person, carries on a business seeking or obtaining for any person or supplying to any person any information described in subsection (2). (2) For the purposes of this section, information (a) means any information relating to (i) the personal character, actions, or behaviour of any person; or (ii) the financial position of any person; or (iii) the occupation or business of any person; or (iv) the identity or whereabouts of any person; but (b) does not include information that is contained in a public record. (3) For the purposes of this section but without limiting the meaning of the term carries on any business, a person is carrying on a business if he or she holds himself or herself out to the public as being ready to carry on that business. (4) Despite subsection (1), no person is a private investigator within the meaning of this Act by reason of the fact that (a) he or she seeks, obtains, or supplies any information (i) for or to the Crown, or any constable, or any local authority; or (ii) at the request of a person who is not a client of the business; or (iii) only as a necessary, usual, or reasonable incident of any other activity by that person that is not described in that subsection; or (iv) for any purpose relating to the dissemination of news or other information to the public or to any section of the public; or (v) for any cultural or historical purpose or for any purpose relating to education, literature, or science; or (vi) relating only to the person by whom he or she is engaged or retained; or (vii) in the course of and for the purposes of the business of a bank, or of a credit bureau, or of a debt collecting agency; or (b) he or she is a security technician, security consultant, confidential document destruction agent, property guard, personal guard, or crowd controller. Meaning of security technician (1) In this Act, security technician means a person who for valuable consideration, either by himself or herself or in partnership with any other person, carries on a business (a) installing or repairing on, or removing from, any part of any premises that are not owned or occupied by himself or herself or his or her firm or any of his or her partners (i) a burglar alarm or similar warning device intended to immediately alert a person or persons to the presence of a person or persons in a particular place; or (ii) a locking device for a safe or a strongroom; or (b) installing, operating, causing to be operated, or repairing, on or in, or removing from, any premises or other place not owned or occupied by himself or herself or his or her firm or any of his or her partners, any camera or similar device for the purpose of detecting the commission of any offence by any person. (2) Subsection (1)(b) applies even if more than one purpose exists for the installation, operation, repair, or removal of the camera or similar device so long as one of the purposes is to detect the commission of any offence by any person. Meaning of security consultant (1) In this Act, security consultant means a person who for valuable consideration, either by himself or herself or in partnership with any other person, carries on a business (a) entering any premises that are not owned or occupied by himself or herself or his or her firm or any of his or her partners for the purpose of selling or attempting to sell any device of the kind referred to in paragraph (a) or (b) of section 6(1); or (b) entering any premises that are not owned or occupied by himself or herself or his or her firm or any of his or her partners for the purpose of advising the owner or occupier of the premises on the desirability of having installed on the premises any, or any further, such device; or (c) entering any premises that are not owned or occupied by himself or herself or his or her firm or any of his or her partners for the purpose of advising the owner or occupier of the premises on the desirability of having guarded the premises or any other property that may from time to time be on the premises or dispatched from the premises. Meaning of repossession agent In this Act, repossession agent means a person who for valuable consideration, either by himself or herself or in partnership with any other person, carries on a business of repossessing consumer goods on behalf of a creditor. Meaning of confidential document destruction agent (1) In this Act, confidential document destruction agent means a person who for valuable consideration, either by himself or herself or in partnership with any other person, carries on a business (a) collecting, for destruction, documents identified as being of a confidential nature; and (b) destroying those documents. Page 10 For more information visit www.pspla.govt.nz PSPLA 02/15 - D

Legislative extract definitions of classes of business (contd) Meaning of property guard (1) In this Act, property guard means a person who for valuable consideration, either by himself or herself or in partnership with any other person, carries on a business (a) guarding, elsewhere than on premises owned or occupied by himself or herself or his or her firm or any of his or her partners, any real or personal property belonging to another person; or (b) monitoring in real time, elsewhere than on premises owned or occupied by himself or herself or his or her firm or any of his or her partners, any of the following: (i) a burglar alarm or similar warning device intended to immediately alert a person or persons to the presence of a person or persons in a particular place: (ii) a camera or similar device; or (c) responding to any device in paragraph (b)(i) or (ii) that has been activated and that is on any part of any premises that are not owned or occupied by himself or herself or his or her firm or any of his or her partners. (2) A person is not a property guard solely because he or she does the work described in section 8. Meaning of personal guard (1) In this Act, personal guard means a person who for valuable consideration, either by himself or herself or in partnership with any other person, carries on a business (a) guarding a specific person or persons; or (b) guarding a specific person or persons and keeping order at any place (not being premises or a conveyance licensed under the Sale of Liquor Act 1989) where the person or persons being guarded may be. Meaning of crowd controller (1) In this Act, crowd controller means a person who for valuable consideration, either by himself or herself or in partnership with any other person, carries on a business doing all or any of the following: (a) screening entry to a place (other than simply ensuring that admission has been paid or that those entering have appropriate invitations or passes): (b) keeping order in a place (more than merely being expected to draw the attention of others to behaviour that is inappropriate or threatens to become inappropriate): (c) removing any person from a place. (2) A person is not a crowd controller solely because he or she does the work described in section 10. Page 11 For more information visit www.pspla.govt.nz PSPLA 02/15 - D