Industrial Security Program

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Request for Private Sector Organization Screening (PSOS) for a Canadian Organization

A – Type of Application (check one)

A – Type of Application (check one)

B – Information on Proposed Canadian Organization

11 – Preferred language of correspondence (check one)

C – Information on Registered or Head Office in Canada (if different from above)

D – Reason(s) for PSOS Request (check those that apply and provide details in space provided)

D – Reason(s) for PSOS Request (check those that apply and provide details in space provided)





E – Information on Security Requirements

1 – Indicate level(s) of personnel security screening required (check those that apply)

* This level is required for access to PROTECTED A, PROTECTED B AND PROTECTED C information or assets

2 – Will the proposed organization be required to store PROTECTED/CLASSIFIED information/assets?
A – If yes, indicate security level(s) of information/assets to be stored (check those that apply)* Also, provide address(es) where information/assets will be stored in sections B and C below.

*Please attach a completed Security Requirements Check List (SRCL)

F – Information on Procurement Officer / Project Manager Requesting PSOS (if different from G)

9 – Signature of Approved Source

G – Information on Approved Source proposing PSOS

Information on Approved Source proposing 9 – Signature of Approved Source

How To Reach Us:

Telephone (Toll Free) 1-866-368-4646

Email ssi-iss@tpsgc-pwgsc.gc.ca

Web site http://ssi-iss.tpsgc-pwgsc.gc.ca