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ShopLifter BannedForm
Please ensure this is filled out correctly and a photo taken of the individual who is banned. please send the photo to control as well as attaching to the form.
9
Questions
START
1
Guard Name
*
This field is required.
First Name
Last Name
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2
Store Name and Location
*
This field is required.
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3
Date
*
This field is required.
/
Date
Year
Month
Day
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4
Time
1
2
3
4
5
6
7
8
9
10
11
12
1
2
3
4
5
6
7
8
9
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11
12
Hour
00
10
20
30
40
50
00
10
20
30
40
50
Minutes
AM
PM
AM
AM
PM
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5
The name of the person being banned.
*
This field is required.
Please check ID if possible
Mr.
Mrs.
Mr.
Mr.
Mrs.
Prefix
First Name
Last Name
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6
Please provide details of full incident and reason for banning order
Huge
Large
Normal
Small
Ok
quote
Created with Sketch.
Ok
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7
Please take a photo of the individual
Attach the photo of the individual and keep a copy send one to control and attach one here.
Drag and drop files here
Select files to upload
Max. file size
: 10.6MB
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8
If a Theft attempt was made please write the value of the attempted theft
Please get a training receipt from shop of the theft attempt
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9
Signature
Clear
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Should be Empty:
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