APPLICATION FOR A DUPLICATE LICENCE, PERMIT, …

1 SAPS 517(b)Page 1 of 5 SOUTH AFRICAN POLICE SERVICEAPPLICATION FOR A DUPLICATE LICENCE, PERMIT, CERTIFICATES OR authorization FOR LOST, STOLEN AND DEFACED LICENCESS ection 29(2), 44(2), 58(2), 72(2) and 82(2) of the Firearms Control Act, 2000 (Act No 60 of 2000)OFFICIAL DATE OFFICIAL USE BY THE POLICE STATIONWHERE THE APPLICATION IS CAPTURED APPLICATION reference No 1 DATE OFFICIAL USE BY POLICE STATION WHERE THE APPLICATION IS RECEIVED1 Province2 Area3 Police station4 Component code5 Firearm applications register reference NoSAPS 86 NOYEARC. PARTICULARS OF LICENCE, PERMIT OR AUTHORIZATIONTYPE OF LICENCE, PERMIT OR authorization (Indicate with an X) 1 Competency certificate3 Licence issued to particular categories of trade in firearms Licence to deal in firearms and manufacture to manufacture firearms and conduct business as a to conduct business as a possess a to possess ammunition in a private to possess a firearm for to possess ammunition in a public to possess a restricted firearm for to possess a firearm for occasional huntingand to possess a firearm for dedicated huntingand dedicated s to possess a firearm in a private to possess a firearm in a public collection(museums) import and export to possess a firearm for business purposes.

2 Business in import-/export to possess a firearm for business purposes:Other business purposes SAPS 517(b)Page 2 of 5continue provide security services for its own business Temporary authorization to possess a a sports-shooting and/or hunting authorization to trade in firearms a collectors authorization to a manufacturer to displayfirearms and a authorization to conduct business as a public collector of firearms and a game a shooting an official provide provide firearms for use in theatrical, film or conduct business in hunting 7 State reason for the APPLICATION for a DUPLICATE licence (Indicate with an X) reason(s)8 Particulars of original licence, permit or authorizationLicence, permit or authorization numberDate issuedExpiry you report the loss of your licence, permit or authorization at your nearest police station within 24 hours?

3 YESNOIf no, submit reason why the loss of your licence, permit or authorization was (s) yes, submit the following station where the loss/theft of your licence, permit or authorization was reference number10 DETAILS OF FIREARMIn case of a licence, temporary authorization to possess a firearm or an import/export permit the following particulars must be submitted (1) (2) (3) (4) SAPS 517(b)Page 3 of 5 Firearm component serial serial serial OF THE HOLDER OF THE LICENCE, PERMIT OR AUTHORIZATION1 NATURAL PERSON S number of natural person---2 Passport number of natural person3 Surname Initials45 Residential addressPostalCode6 7 Postal address Postal Code89 Telephone number Home( ) Work( ) number Fax( )1011E-mail address12 JURISTIC PERSON S DETAILS13 OTHER BODIES14 Registered company name15 Trading as name16 FAR number17 Postal address Postal Code1819 Business address Postal Code2021 Business telephone number ( ) Fax( )

4 22E-mail address23 RESPONSIBLE PERSON S DETAILS24 Responsible person (full name and surname)25 Type of identification (Indicate with an X)SA IDPassport number26 Identity number of responsible person---27 Passport number of responsible person28 Cellphone number29 Physical addressPostalCode30 SAPS 517(b)Page 4 of 531 Postal address Postal Code3233 DECLARATION BY APPLICANTI am aware that it is an offence in terms of section 120 (9)(f) of the Firearms Control Act, 2000 (Act No 60 of 2000), to make a false statement inthis OF APPLICANT (Sign only if applicable)Note:The requirements of the photo:- The photograph must be in colour and may not exceed the border.

5 - The photo must be the size of a standard passport The photo must be a full front view of the head and shoulders of the The background of the photo must be The applicant may not be wearing a hat or sunglasses on the The applicant s name and identification number must be written on the back of the photograph before it is affixed on the APPLICATION The applicant must sign in black The signature may not exceed the The whole finger must be pressed down on the The fingerprint should not be rolled and must be a flat designation3 2 Signature5 Date-- 6 Name of applicant in block letters 7 Place8 PARTICULARS OF POLICE OFFICIAL DEALING WITH of police official in block letters Persal number of police official of police official in block lettersSignature of police official9 PARTICULARS OF of witness in block letters Persal number of of witness in block lettersSignature of witness SAPS 517(b)Page 5 of OF INTERPRETER (This section must be completed only if the applicant cannot read or write or does not understand the content of this form.)

6 1 Name and surname of interpreter2 Identity/Passport number of interpreter3 Residential address Postal Code45 Postal addressPostal Code6 7 Telephone number Home( ) Work ( ) number Fax( )910E-mail address11 Interpreted from (language)to12 Date--1314 PlaceSignature of interpreter1516-Rank of police official in block letters (if applicable) Persal number of police official (if applicable) OFFICIAL USE BY THE POLICE STATION12 Date--Name of police official in block letters34 PlaceRank of police official in block letters 56-Signature of police officialPersal number of police official