Police Service of Northern Ireland

APPENDIX G RESTRICTED Page 1 of 3 `POLICE SERVICE OF NORTHERN IRELAND VARIATION IN DETAILS RELATING TO AN UNIQUE REFERENCE NUMBER

EXISTING UNIQUE REFERENCE NUMBER: Does this URN refer to a combination system? Each chargeable event, (Box 5), will incur a charge for each element currently £43.49 plus VAT YES NO Is a police response still required for both elements? i.e. Intruder or Hold-up. If YES – proceed to Box 1. YES NO If NO – which element is not required? This element will be deleted from the URN. Intruder Hold-up Have appropriate measures been put in place to ensure signals are not passed to police YES NO Any subsequent requirement for the element that has been deleted will require a new URN. The user may need to consult their insurance company, if an element has been removed. 1. ALARM COMPANY 4. REMOVALS Please tick: √ Name: Cancellation of URN: Address: Please sign and date below. Submit this page only. Signature: Date:

5. AMENDMENTS Please tick: √ Post Code: (Chargeable event) Trading name (Box 2):

Tel No: (Chargeable event) Client (Box 2): Fax No: Correspondence Address (Box 3): 2. PROTECTED PREMISES (Chargeable event) Alarm Company (Box 6): Name: ARC (Box 7): Trading Name: Keyholder (Box 8 – 11):

Premises Type: Additional Features e.g. smoke generator(Box12): Address: Hazards (Box 13): 6. PREVIOUS ALARM COMPANY Name: Address:

Post Code: Tel No: 3. CORRESPONDENCE ADDRESS Post Code: Name: 7. ALARM RECEIVING CENTRE

Address: Name: Address:

Post Code: Correspondence to be sent to: √ Correspondence address only, or Post Code: Premises and correspondence address Tel No:

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8. KEYHOLDER 1 9. KEYHOLDER 2 Name: Name: Address: Address:

Post Code: Post Code: Home Phone: Home Phone: Work Phone: Work Phone: Mobile: Mobile: 10. KEYHOLDER 3 11. KEYHOLDER 4 Name: Name: Address: Address:

Post Code: Post Code: Home Phone: Home Phone: Work Phone: Work Phone: Mobile: Mobile: 12. ANY OTHER DETAILS

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

RESTRICTED APPENDIX G RESTRICTED Page 3 of 3 POLICE SERVICE OF NORTHERN IRELAND CHANGES IN SITE HAZARDS - HEALTH & 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. So officers may be pre-warned of site risks you are required to state any site hazards. 13 Hazard details apply to the building(s) and grounds of these premises. Please tick: √

CONTAGIOUS POND BASEMENT DOGS SAMPLES FLAMMABLE SWIMMING POOL FRAGILE ROOF DANGEROUS ANIMALS SUBSTANCES DANGEROUS RIVER FRONTAGE FIREARMS FUEL STORAGE STRUCTURE GLASS COPING WALLS LOW CEILING BEAMS AMMUNITIONS CHEMICALS RADIO ACTIVE RAZOR WIRE SLIPPERY FLOORS EXPLOSIVES MATERIALS INSPECTION PITS FURNACE DANGEROUS MACHINERY ASBESTOS ELECTRICITY SUB- SPRINKLER SETTLEMENT TANKS GAS CYLINDERS STATION SYSTEM VATS ATM INSIDE PREMISES TOXIC MATERIALS

STATE OTHER SITE HAZARDS OR IF NO SITE HAZARDS OR RISKS, STATE NONE:

Should site circumstance 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 Requirements & Response to Security Systems and the PSNI Annexe A, Additional Operation Restrictions for PSNI. This Policy can be downloaded from: http://www.securedbydesign.com/wp- content/uploads/2015/08/Security_Systems_Policy_2015.pdf and www.psni.police.uk/index/crime- prevention/security_systems_policy.htm. 2. I am aware that there is a police Alarms 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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