FORM T-01

Revised AUGUST 2016

(THIS FORM IS FREE OF CHARGE AND CAN BE REPRODUCED.) 2 PIECES LATEST

2” X 2” PICTURE
APPLICATION FORM FOR NEW ACCREDITATION WITH WHITE
BACKGROUND
& NAME TAG
Please check (√) the category you are applying for.
CATEGORY:
Training Director Training Officer Training Instructor
DATE FILED:
I.GENERAL INFORMATION
LAST NAME FIRST NAME MIDDLE NAME QUALIFIER

PRESENT ADDRESS (HOUSE NO.,STREET, BRGY., TOWN /CITY , PROVINCE) TELEPHONE NO. /CELL NO.

PERMANENT ADDRESS (HOUSE NO.,STREET, BRGY., TOWN/ CITY,PROVINCE) REGION:

BIRTH DATE (Month/Day/Year) BIRTH PLACE (Town/ City/Province)

SEX CIVIL STATUS HIGHEST EDUCATIONAL ATTAINMENT RELIGION

[ ] MALE [ ] SINGLE [ ] WIDOW/ER [ ] COLLEGE GRADUATE (specify Course)_____________________________
[ ] FEMALE [ ] MARRIED [ ] SEPARATED [ ] POST GRADUATE (specify Course)__________________________________
II. RELATED TRAININGS/ SEMINARS ATTENDED ON PRIVATE SECURITY
NUMBER OF INCLUSIVE DATES
TITLE VENUE
HOURS FROM TO

(Use additional sheet if necessary)

III. CATEGORIES (Please check your field of specialization)
____ Mall and Commercial Security
____ Bank and Armor Security ____ Drills and Inspection
____ Marksmanship/Gun Safety Handling
____ Basic Communication ____ Emergency Preparedness
____ Physical Security System
____ Basic Life Support/ First Aid ____ Fire Prevention and Control
____ VIP/Personal Security and Protection
____ Bomb Awareness and Detection ____ Gender Awareness and Development
____ Report Writing
____ Intelligence
____ Customer/Public Relation ____ Values Formation
____ Investigation
____ Courtesy and Discipline ____ Security Survey
____ Law Enforcement
____ Defense Tactics/ Disarming Technics ____ Security Management
____ Legal Aspect
____ Others ___________________________
IV. COMMON REQUIREMENTS FOR ALL APPLICANTS except for Active and Retired AFP/PNP/BFP
1. College Diploma (Certified True Copy by issuing School) 5. Neuro-Psychiatric Test Result (Original)
2. Transcript of Records (Certified True Copy by Issuing School) 6. Barangay Clearance (Original)
3. NBI Clearance (Original) 7. City/Municipal Police Clearance (Original)
4. Drug Test Result (Original)
For Active AFP/ PNP/BFP For Retired AFP/PNP/BFP
Endorsement from CO or Chief of Office (Original) Retirement order (Certified True Copy)
V. ADDITIONAL REQUIREMENTS
1. Training Director – Master’s Degree Diploma, Certification of Admission to the BAR if applicant is a graduate of Bachelor of Law (Photocopy)
2. Training Officer & Training Instructor - Security Trainer’s Training Methodology or its equivalent (Photocopy)

I HEREBY CERTIFY that all entries I made herein are true and all documents I have attached are genuine and valid to the best of my knowledge.

SIGNATURE

PRINTED NAME

LEFT THUMBMARK RIGHT THUMBMARK

WARNING: Applications with incomplete or false entries and with fake or invalid documents will not be processed. Same may be used by
SOSIA as basis in filing administrative and / or criminal complaint against the applicant.

Control No. ______

IMPORTANT: SEE BACK PAGE for instructions and guide in organizing application and documents.
Tear here _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
CLAIM STUB

Please claim/receive your Certificate of Accreditation on _______________________at___________________________

_________________________________________.
Received by: Date received:
_______________________________________ ________________________________
OP # _____________ Date: ________________
SBR # ____________ Date: ________________
Control No. _____
 TABLE OF CONTENTS
NEW
TRAINING DIRECTOR TAB

Résumé (Original) A
Master’s Degree Diploma and Transcript of Records (Original and Photocopy) B
Certification from President or General Manager of Private Security
Industry that he has 5 years work experience. C
Drug Test Result (Original) D
Neuro-Psychiatric (NP) Evaluation Report (Original) E
NBI Clearance (Original) F
Local Police Clearance (Original) G
Barangay Clearance (Original) H

TRAINING OFFICER TAB

Résumé (Original) with 2x2 white background picture A

Certification from President or General Manager of Private Security Training Institute
that he/she has three (3) years work experience as Trainer B
Certificate of Trainers Training Methodology Course or its Equivalent Course C
College Diploma and Transcript of Records (Original and Photocopy) D
Drug Test (Original) E
NP Clearance conducted by any PNP Accredited Testing Center F
NBI Clearance (Original) G
Local Police Clearance (Original) H
Barangay Clearance (Original) I

TRAINING INSTRUCTOR TAB

Résumé (Original) with 2x2 white background picture A

Certificate of Trainers Training Methodology Course or its Equivalent Course B
College Diploma and Transcript of Records (Original and Photocopy) C
Drug Test (Original) D
NP Clearance conducted by any PNP Accredited Testing Center E
NBI Clearance (Original) F
Local Police Clearance (Original) G
Barangay Clearance (Original) H

Who shall file : Any Filipino citizen not less than 21 years of age after complying both the
academic/scholastic and skills/training requirements subject to other
requirement prescribed by RA 5487.
How to file : Fill out this Application form T – 01 and submit application folder with
complete requirements.
Where to file : To STMD, SOSIA, CSG Camp Crame, Quezon City with endorsement from
Regional Security Agencies and Guards Section (RSAGS) for applicant
based outside Metro Manila.
When to file : Monday to Friday 8:00AM to 5:00PM except holidays

For inquiry please contact STMD Office with this no. 650-3542 and RCSU _______

FEES
Category Accreditation fee License Fee ID Card TOTAL
Service Provider
Training Director Php450.00 Php450.00 Php150.00 Php1,050.00
Training Officer Php450.00 Php450.00 Php150.00 Php1,050.00
Training Instructor Php450.00 Php450.00 Php150.00 Php1,050.00