APPENDIX F

POLICE SERVICE OF NORTHERN IRELAND

APPLICATION FOR THE ISSUE OF AN UNIQUE REFERENCE NUMBER

INTRUDER AND / OR HOLD UP ALARM SYSTEM

Does this application refer to an existing or withdrawn URN? / YES / NO
IF YES WHAT IS THE URN?
Please include NSI / SSAIB Certificate of Compliance and quote Certificate Number:
What is the Alarmed Premises Grid Reference?
If applicable have you included Appendix F Annexe A / B and attached any required evidence eg. 90 day report from ARC? / YES / NO
HAVE 2 KEY HOLDERS WHO RESIDE WITHIN 20 MINUTES FROM THE PROTECTED PREMISES BEEN SUPPLIED TO THE ARC?? PLEASE SIGN BELOW / YES / NO
PLEASE SIGN ON BEHALF OF SECURITY COMPANY
1. / ALARM COMPANY / 4. / TYPE OF SYSTEM / Please √
Name: / INTRUDER
Address: / HOLD UP
5. / TYPE OF CONFIRMATION / Please √
PLEASE TICK AS REQUIRED / IA / HU
/ AUDIO

Post Code:

/ VISUAL
Tel No: /

SEQUENTIAL

/ /
2. / PROTECTED PREMISES / TELEPHONE (CALL BACK)
Name: /

6.

/

STANDARD TO WHICH INSTALLED

/

Please √

Trading Name: /

PD6662:2004

/

Premises Type:

/

BS8243:2010

/

Address:

/

PD6662:2010

/
/

7.

/

GRADE OF SYSTEM

/

Please √

/

GRADE 2

/

Post Code:

/

GRADE 3

/

Tel No:

/

GRADE 4

/
3. / CORRESPONDENCE ADDRESS / 8. / ALARM RECEIVING CENTRE
Name: / Name:
Address: / Address:
Post Code:
Correspondence to be sent to: Please √
Correspondence address only, or / Post Code:
Premises and correspondence address / Tel No:

POLICE SERVICE OF NORTHERN IRELAND

HAZARDS AND SITE RISKSHEALTH & SAFETY ACT

(MUST BE COMPLETED BY OCCUPIER)

Police officers will not normally enter the premises without the keyholder. However, this may be necessary on occasions due to suspicious circumstances. In order that attending Police Officers may be pre-warned, you are required to state any site hazards or risks.

9. / Hazard details apply to the building(s) and grounds of these premises. / Please tick: / √
POND / BASEMENT / DOGS / CONTAGIOUS SAMPLES
SWIMMING POOL / FRAGILE ROOF / DANGEROUS ANIMALS / FLAMMABLE SUBSTANCES
RIVER FRONTAGE / DANGEROUS STRUCTURE / FIREARMS / FUEL STORAGE
GLASS COPING WALLS / LOW CEILING BEAMS / AMMUNITIONS / CHEMICALS
RAZOR WIRE / SLIPPERY FLOORS / EXPLOSIVES / RADIO ACTIVE MATERIALS
INSPECTION PITS / FURNACE / DANGEROUS MACHINERY / ASBESTOS
SETTLEMENT TANKS / ELECTRICITY SUB-STATION / GAS CYLINDERS / SPRINKLER SYSTEM
VATS / ATM INSIDE PREMISES / TOXIC MATERIALS
10. / PLEASE STATE ANY ADDITIONAL SITE HAZARDS – ADDITIONAL FEATURES – DIRECTIONS ETC

Should site circumstances change you must update our records.

1.  I have been given Appendix ‘I’ and Appendix ‘H’ by the Security Company. I have read, understand and agree to abide by the NPCC Guidelines on Police Requirement & Response to Security Systems and the PSNI Annexe A, Additional Operation Restrictions for PSNI. This can be downloaded from: www.psni.police.uk/security-systems

2.  I am aware that there is a police Alarm Administration fee payable (£43.49 + VAT) on the issue of each PSNI Unique Reference Number.

3. In particular I have noted the keyholder requirements.

Signed (Customer):

If this form is not completed the Appendix will be returned unprocessed.

Signed (by or on behalf of the Alarm Company):
Position in Company:
Date:

Data Protection Act 1998 Personal data supplied on this form may be held on, and/or verified by reference to information already held on computer.

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