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Authorised Signatory RequestOrg-6.

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Applicants Details

Org. Prefix ID N°

Job Title

Organisation

(Applicants) (Applicants)

Date Received at the ID CentreSecurity ID Department Use Only

Yes (If yes, complete the details below)No

Application Reason

Surname

Forename

Middle Names

Has the applicant any Middle Names?

Department

Place of Birth

Contract Expiry DateEmployment/Contract Start Date

Employment Type

Initial Renewal

Date of Birth

Has the applicant previously held a Security ID at this airport? Yes No

Nominated Officer· CAUTION Under Section 21B Subsection (1) of the Aviation and Maritime Security Act 1990, It is an offence to:- give false information

either for the purpose of or in connection with an application for an identity document (pass) or in connection with the continued holding of an identity document that has already been issued. Offenders may be prosecuted and fined.

· All information given in this application is correct to the best of my knowledge and belief.

· I have read and agree to the above caution and I understand it. Signature

NameDate

Full-time / Part-time Contract

Fixed-term Contract

Freelance/Consultant/Contractor

Agency Staff

Address /Residence

Post Code

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Authorised Signatory RequestOrg-6.

Applicants Details - continued

FemaleMaleGender

Nationality(s)

Email address

Org. Prefix ID N°(Applicants) (Applicants)

Applicant Name Applicant Date of Birth

Nominated Officer· CAUTION Under Section 21B Subsection (1) of the Aviation and Maritime Security Act 1990, It is an offence to:- give false information

either for the purpose of or in connection with an application for an identity document (pass) or in connection with the continued holding of an identity document that has already been issued. Offenders may be prosecuted and fined.

· All information given in this application is correct to the best of my knowledge and belief.

· I have read and agree to the above caution and I understand it. Signature

NameDate

National Insurance N° (or equivalent)

Telephone N°

Yes n/aHas a valid and genuine criminal record certificate been obtained and examined for any disqualifying convictions?

YesHas the person's identity been verified through a document or database check?

Do employment references come from legitimate sources and do they appear genuine?

Do all the dates align so there is documentary evidence to cover the full 5-year period with no gaps of over 28 days?

Where an applicant was registered with an agency (or may be employed on a zero-hour's contract with more than one company) is there some independent supplementary evidence to illustrate how often the applicant was working (e.g. Gap reference or bank statements)?

Where the applicant has provided the referee contact details, has someone tried to verify the authenticity of the referee and the reference provided?

Where a gap reference has been provided, is there evidence to show how the referee knew what the person has been doing or any other supporting evidence?

Yes n/a

Yes n/a

Yes n/a

Yes n/a

Yes n/a

BDC Serial N° Issue Date

Are Overseas Criminal Records required and have been obtained and examined for any disqualifying convictions?

Yes n/a

Is the content of the references consistent with information supplied by the applicant? Yes n/a

All file notes and details to pass the background check have been documented.

A record of the background check, including copies of the identity document checked, criminal record certificates, references used to support the personal history and any file notes, will be retained for the duration of the person's employment or 2 years, whichever is the greater.

Yes

Yes

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Authorised Signatory RequestOrg-6.

Company Prefix ID N°(Applicants) (Applicants)

Applicant Name Applicant Date of Birth

I am satisfied and have personally approved & passed the applicants background Check relevant to the type of Security ID requested.

I consider the applicant to be suitable to hold a Security ID that gives access into the Critical Part of the SRA of a UK Airport.

Copies of all supporting documents & file notes are included with this application.

Yes

Yes n/a

Yes

Date

Nominated Officer

Name Position

Telephone N°

Email address

Company

Signature

The person detailed in this request has been nominated: · To act as an Authorised Signatory on behalf of this company for all Security ID applications. · In accordance with MAG Security ID Standard and have been made aware of section 21B(1)(A) of the Aviation Security

Act 1982/1990 (as amended) and of the associated penalty at Section 21B(5). CAUTION Under Section 21B Subsection (1) of the Aviation and Maritime Security Act 1990, It is an offence to:- give false information either for the purpose of or in connection with an application for an identity document (pass) or in connection with the continued holding of an identity document that has already been issued. Offenders may be prosecuted and fined. · All information given in this application is correct to the best of my knowledge and belief. · I have read and agree to the above caution and I understand it. · I confirm that the applicant who I have requested to become an Authorised Signature meets the MAG Security ID

Standard requirements required and will be suitably trained to carry out their responsibilities for the role of Authorised Signatory in accordance with Department for Transport / CAA directives.

· Any Authorised Signatory renominated on behalf of this company does not have any disqualifying convictions (as defined by the Department for Transport / CAA for Security ID cards giving access to the Critical Part of a UK airport). I undertake to immediately notify the ID Centre in the event that an Authorised Signatory is convicted of a disqualifying offence during the lifetime of membership of the Security ID Scheme.

· I will advise the ID Centre in writing of changes to the signatories when they occur, by submission of a 'Org 8 - Authorised Signatory Cancellation' form.

(Please be aware mandatory training by the ID Centre will also be required in addition to any training you have provided for the Authorised Signatory).