MEMBERSHIP APPLICATION

MEMBERSHIP APPLICATION FORM

Company Details

Registered Company Name: *

Business Trading Name: *

Private Security Authority Licence Number: *

Registered CRO No.: *

Trade commenced: *

Business Address: *

Registered Office: *

Telephone / Landline: *

Mobile: *

Email: *

Website: *

Sector of Industry in which engaged: *

Number of staff: *

Fulltime: *

Parttime:

Annual Turnover: *

Vat Registration Number: *

Tax Clearance:

Insurance Cover (attach copy schedule) *

Choose File

Standards achieved:

Standards (attach copy if applicable)

Choose File

Directors:

Director 1: *

Details of previous Directorships in last 10 years

Director 2:

Details of previous Directorships in last 10 years

Director 3:

Details of previous Directorships in last 10 years

Director 4:

Details of previous Directorships in last 10 years

Memberships:

Membership of other Associations:

Details of Auditors:

Name of Auditors: *

Auditors Address: *

Auditors Phone: *

Contact Name:

Declaration:

I/We hereby give the ISIA permission to make representations to our company’s Auditors directly for a financial statement to the company.

I/We certify that the foregoing information is correct to the best of my/our knowledge. If this application is approved I/We agree to observe the rules and bye-laws of the Association and to participate actively in all lawful activities, to the advancement and growth of the Association, as may be required from time to time.

Name: *

Position: *

Date: *

The completed application form, together with a non-refundable application fee of €250 +Vat @23% (€307.50) should be forwarded to ISIA, Chase House, City Junction Business Park, Northern Cross, Malahide Road, Dublin 17

Thank you for your ISIA Membership Application. We will revert to you shortly.

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