FORM A-3 (for individual) size photograph of the licensee

1 Recent passportsizephotograph ofthe licenseeForm of application for renewal of Arms Licenses(s) granted inForm II, III & IV(See rule 24)IDENTITY OF THE of birth in Christian era(a)in figures_____ / _____ / _____( DD/MM/YYYY )(b)in Address(a) Telephone (Office/Residence)(b) Mobile No.(c) E-mail(d) Nearest Police AddressLicence Particulars and Weapon of expiry_____ / _____ / _____ ( DD/MM/YYYY ) EndorsedWeapon 1 Weapon 2 Weapon 3(a) Type(Rifle/Shotgun/Handgun( revolver / Pistol) etc.(b) Bore / Caliber(c) Weapon allowedCartridges Gun Powder/Percussion CapsFORM A-3(for individual) OTHER PARTICULARS OF THE the applicant since last renewal or issuance of licence has been -(a) convictedYNIf yes, details thereof -OffenceSentenceDate of sentence _____ / _____ / _____(DD/MM/YYYY)(c) ordered to execute a bondunder Chapter VIII of Codeof Criminal Procedure,1973 (2 of 1974) forkeeping the peace or forgood behaviourYNIf yes, details thereof Date _____ / _____ / _____(DD/MM/YYYY)Period for whichbound(c) prohibited under the ArmsAct, 1959, or any other lawfrom having the arms orammunitionYNIf yes, details thereof Date _____ / _____ / _____(DD/MM/YYYY)Period for which -(a))

2 The applicant s licence sincelast renewal or issuance oflicence was ever suspendedor cancelled/ revokedYNIf yes, details thereof Name of the licensing authorityReasons(b) any other member of theapplicant s family is inpossession of any armslicence, if so, particularsthereofYNIf yes, details thereof NameLicense (d)the applicant has a safe placeto keep the arms andammunitionYNIf yes, details thereof-(e)the applicant has undergoneprescribed training asspecified under rule 10(whenever made applicable by theCentral Government)YNIf yes, details thereof-Declaration:I hereby declare that the above particulars given in the application are true, complete and correct to the best of my knowledge and belief. Iunderstand that in the event of any information being found false or incorrect at any stage, I am liable to be proceeded against and action taken underthe relevant provisions of the Arms Act, 1959, the Arms Rules, 2016, and other central enactments or the law for the time being in (Signature /Thumb-impression of applicant)Place _____Date_____Views of the weapon inspecting officer with amount of fees realized.

3 _____(Signature of the inspecting officer)Order of the renewing authority : .._____(Seal & Signature of the renewing officer)