Membership Type (required)
---OrdinaryAssociateFounding

Company Name (required)

Trading Name (required)

Registered Trading Address

Street / PO Box (required)

Suburb / Town (required)

State (required)

Postcode (required)

Telephone (required)

Fax (required)

Email (required)

Website (required)

Contact Person (required)

Contact Title (required)

Contact Mobile (required)

Security Firms Licence Class (required)

Licence Number (required)

Expiry (required)

Individual Security Licence Number (required)

Expiry (required)

Registered Cabling Licence Number (required)

Name of Registrar (required)

Please attach copies of all licences and the following:
- Public Liability Insurance Certificate of Currency
- Professional Indemnity Insurance Certificate of Currency
- ABN/Business Name Registration
- Workers Compensation Insurance Certificate of Currency
- Certificate of Incorporation
- List of Company Directors/Partners (including address)
I authorize ESA to obtain from credit reporting agencies, credit reports for individuals and/or companies. I also authorize ESA to carry out an inspection of premises, business systems, installations and conduct relevant interviews to ascertain my/our suitability for membership.
I/We agree to be bound by the constitution of the ESA, it’s code of practice, policies and procedures and the relevant acts pertaining to licencing of security firms and individuals in the states and/or territories in which they transact business.
I declare that the information that is provided in this application is true and correct.

Applicant's Name (required)

Date

Nominated By

Seconded By