Permits

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*

Postal Address*

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)

Surname

Relationship to applicant

Age

Sex

Date of birth

7. Additional Dependants

First Name(s)

Surname

Relationship to applicant

Age

Sex

Date of birth

I confirm that all the above content is complete and correct.