APPLICATION FOR LICENCE TO POSSESS A FIREARM

1 SAPS 271 Page 1 of 12 SOUTH AFRICAN POLICE SERVICEAPPLICATION FOR LICENCE TO POSSESS A FIREARMS ection 12, 13, 14, 15, 16, 17, 19 and 20 of the Act, 2000 (Act no 60 of 2000) OFFICIAL DATE OFFICIAL USE BY THE POLICE STATIONWHERE THE APPLICATION IS CAPTURED APPLICATION reference No 1 Number of applicationof2 DATE OFFICIAL USE BY POLICE STATION WHERE THE APPLICATION IS RECEIVED1 Province2 Area3 Police station4 Component code5 FIREARM applications register reference NoSAPS 86 NOYEARC. FOR OFFICIAL USE BY THE CENTRAL FIREARMS REGISTER (CFR) Outstanding/Additional information required 1- Persal number-- Date23 Signature of police official Name in block letters45 APPLICATION for LICENCE approved (Indicate with an X)6- Persal number-- Date78 Signature of CFR officer Officer code Name in block letters91011 APPLICATION for LICENCE refused (Indicate with an X) Reason(s)

2 For refusal1213- Persal number-- Date1415 Signature of CFR officer Officer code Name in block letters161718 SAPS 271 Page 2 of OF APPLICATION FOR A LICENCE TO POSSESS A FIREARM (S) Main FIREARM LICENCE holder Additional FIREARM LICENCE holder(Indicate with an X) 1 2 3 SectionnumberType of LICENCE /permitPeriod to POSSESS a FIREARM for self-defenceFive to POSSESS a restricted FIREARM for self-defenceTwo to POSSESS a FIREARM for occasional hunting and/or sport-shootingTen to POSSESS a FIREARM for dedicated hunting and/or dedicated sport-shootingTen to POSSESS a FIREARM in a private collectionTen years3.

3 619 LICENCE to POSSESS a FIREARM , in a public collectionTen 20 LICENCE to POSSESS a FIREARM for business purposes: Business in huntingFive to POSSESS a FIREARM for business purposes: Other business purposesTwo years3. 920 LICENCE to POSSESS a FIREARM for business purposes: For use in theatrical, film and TVproductionsTwo to POSSESS a FIREARM for business purposes: As a security businessTwo to POSSESS a FIREARM for business purposes: For training purposesTwo to POSSESS a FIREARM for business purposes: As a game rancherTwo OF FIREARM (Indicate with an X)TYPE OF FIREARM 1 RifleShotgunHandgunCombinationOther, specify (armament/indeterminable designtype)DETAILS OF FIREARM (Indicate with an X) action (specify) and addresses engraved in the Calibre FIREARM component serial number serial number Make serial number PARTICULARS OF CURRENT OWNER1 Type of owner (Indicate with an X) Private ownerBFirearm dealerCCompanyDImported firearmEEstate2 NATURAL PERSON S DETAILS SAPS 271 Page 3 of 123 TYPE A (Private owner)

4 4 SurnameInitials 56 Full names7 Identity number ---8 Residential addressPostal Code 910 Postal addressPostal Code 1112 Telephone number Home( )Work( ) numberFax( )13 14E-mail address15 Are there any additional FIREARM LICENCE holders for this FIREARM ? (Indicate with an X)YESNO16 JURISTIC PERSON S DETAILS17 TYPE B ( FIREARM dealer)18 Registered company name19 Trading as name20 FAR number21 Postal addressPostalCode 2223 Business address PostalCode 2425 Business telephone numberWork( )Fax( ) 26E-mail address27 Responsible person (Name and surname)

5 28 Type of identification (Indicate with an X)SA citizenNon-SA citizen with permanent residence*29 Identity number of responsible person---30 Cellphone number31 Physical addressPostalCode 3233 Postal address PostalCode 3435 SAP 350 (A) DETAILSF irearm received from36 Name37 Identification number or FAR number38 Address39 Postal code Date received--40* In case of a non-SA citizen proof of permanent residence must be submitted. SAPS 271 Page 4 of 1241 TYPE C (Companies)42 Registered company name43 Trading as name44 FAR number45 Postal addressPostalCode 4647 Business addressPostalCode 4849 Business telephone numberWork( )Fax( ) 50E-mail address51 Responsible person (Name and surname)

6 52 Type of identification (Indicate with an X) SA citizenNon-SA citizen with permanent residence*53 Identity number of responsible person---54 Cellphone number55 Physical address PostalCode 5657 Postal addressPostalCode 58 59 TYPE D (Imported firearms)60 Import permit number61 Date issued--62 Expiry date--63 TYPE E (Estate)64 Type of estate (Indicate with an X)65 ExecutorshipAdministratorshipCuratorship Trust66 SurnameInitials 6768 Full names69 Identity number of the owner of the FIREARM ---70 Name and surname of executor, administrator, curator, trustee or liquidator71 Type of identification (Indicate with an X)Non-SA citizen with permanent residence*SA citizen72 Identity number of executor, administrator, curator, trustee or liquidator---73 Telephone number Home( )Work( ) numberFax( )

7 74 75 Physical address PostalCode 7677 Postal addressPostalCode 78* In case of a non-SA citizen proof of permanent residence must be submitted SAPS 271 Page 5 of 1279 Physical address where FIREARM (s) is keptPostalCode 8081 DECLARATION BY PERSON WHO IS LAWFULLY IN POSSESSION OF THE FIREARM (S)I hereby declare that the above FIREARM (s) is/are legally in my possession and that I propose to sell or supply it to the applicant once thenecessary LICENCE (s) has/have been obtained and that the particulars of the FIREARM (s) are correct and 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 and surname of current owner/authorized person83 Identification number of current owner/authorizedperson---84 Designation85 Date--8687 PlaceSignature of current owner/authorized OF APPLICANT (Complete only the section that has bearing on you.)

8 1 PARTICULARS OF EXISTING COMPETENCY CERTIFICATE (Indicate with an X) certificate to trade in certificate to manufacture certificate to conduct business as a certificate to POSSESS a FIREARM (Indicate with an X) certificate of issue-- Expiry OF FIREARMS IN YOUR POSSESSION AND FOR WHICH YOU HAVE A LICENCE , PERMIT OR AUTHORIZATION TypeCalibreMakeBarrel Serial NoFrame/receiver No SAPS 271 Page 6 of 12 3 NATURAL PERSON S DETAILS 4 PRIVATE PERSON 5 Type of identification (Indicate with an X) citizenNon-SA citizen with permanent residence* Identity number of private person---67 Surname Initials8 Full names9 Date of birth-- Age GenderMaleFemale10111213 Residential address Postal Code1415 Postal address Postal Code1617 Type of residence (eg shack, flat, caravan, cottage, house, hostel or homeless)18 Trade or profession If self-employed, specify1920 Name of employer/company21 Business address Postal Code2223 Telephone numberHome( )Work( )

9 Number Fax( )24 25E-mail address26 Marital status (Indicate with an X) SingleMarriedDivorcedWidowWidower27 Other (specify)* In case of a non-SA citizen proof of permanent residence must be submitted SAPS 271 Page 7 of 1228 PARTICULARS OF APPLICANT S SPOUSE/PARTNER 29 Type of identification (Indicate with an X) IDPassport30 Identity number of spouse--- Passport number of spouse3132 Name and surname33 JURISTIC PERSON S DETAILS 34 OTHER BODIES (eg body corporate, close corporation or company) Registered company name 35 Trading as name36 FAR number37 Postal address38 Postal Code39 Business address40 Postal Code4142 Business telephone numberWork( )Fax( )

10 43E-mail address44 Number of firearms already registered to the business45 Number of persons employed by the business to handle firearms46 Respons