1. Please attach all required documents
Certified ID/Passport*
Work Permit or Permanent Residency
Code of Conduct (no older than 12 months)
2. Particulars of Applicant
First Name(s)*
Surname*
Gender*
Identity/Passport Number*
Nationality*
Email Address*
Postal Address*
Residential Address*
Telephone Number (Work)*
Telephone Number (Home)
Fax Number
If permanent resident in Namibia, state Permanent Resident Permit Number
Work Permit Number
Expiry date of Work Permit
3. Particulars of Employer
Name of Employer*
Business Address*
Telephone Number*
Capacity/Position in which person is employed*
4. Particulars of restricted area(s) for which permit is required
Area(s)*
Entry Point(s)*
Purpose for which permit is required*
Date/period for which permit is required*
5. If applicant is spouse, child, other family member or dependent of existing permit holder employed in restricted area, give particulars of such permit holder:
First Name
Surname
Postal Address
Residential Address
Permit Number
Relationship to permit holder
6. Particulars of any dependants under the age of 15 years who should be covered by this permit: Dependant No. 1
First Name(s)
Relationship to applicant
Age
Sex
Date of birth
7. Additional Dependants
I confirm that all the above content is complete and correct.