Application for Firearms Temporary Permit · finding of guilt against you, for any offence, not including minor traffic offences, including - Any interstate or overseas findings of

Temporary Permits Page - 1 -

NORTHERN TERRITORY POLICE Northern Territory Firearms Act 1997

PF446 Ver.4.5

Revised 08/20

APPLICATION FOR FIREARMS

TEMPORARY PERMITS

Read the instructions attached before completing the form.

TO BE LODGED IN PERSON AT A NORTHERN TERRITORY (NT) POLICE STATION

Individual Business Please tick appropriate box

Section 1: Firearms Temporary Permit Type / Category Please tick appropriate box or boxes

Category of firearm you are seeking in this temporary permit

A B C D (*see note) H

*Note: Applications for Category D temporary permits are only considered under special circumstances. You must contact the Firearms Policy and Recording

Unit (FPRU) on (08) 8922 3543 or [email protected] if you are applying for a Category D temporary permit.

Section 2: Type of permit Please tick appropriate box or boxes

Type of permit

To authorise the possession or use of a firearm by a person residing temporarily in the NT

To authorise the holder of a ‘Collector Licence’ to use a firearm held under the Licence (discharge a collector’s piece)

To authorise the possession or use of firearms for film, theatrical productions or other artistic purposes

To authorise the temporary possession or use of a firearm by the holder of a licence for a specified reason not covered

by the holder’s licence

Other reason (Pursuant to Section 31(1) of the Firearms Act 1997) .………………………………………………………..……

……………………………………………………………………………………………………………………………………………...…

Section 3: Genuine Reason / Need Please tick appropriate box or boxes (*see note)

Reason / Need

Animal Welfare

Business or Employment

Firearms Collection

Instruction in Firearms Use and Safety

Museum Display

Occupational Requirements

Primary Production

.Recreational_Shooting_/ Hunting

Sports Shooting

Vertebrate Pest Control

Theatrical Enactment

Special Use Permit (not covered by firearms licence )

*Note: You must provide supporting documentation to support the ‘reason and / or need’ along with this application.

Section 4: Duration Required for NT Firearms Temporary Permit *see note

Duration

Date From ................... / ......................... / ……............... To ……............... / ........................ / ….................

*Note: Interstate applicants - Please ensure the period covers entry and exit into the NT (travel period)

Section 5: Personal Details Please tick appropriate box or boxes

Current Name Surname: Given Name: Middle Name:

Date of Birth

DD / MM / YYYY Sex Male Female Other

(Indeterminate/Intersex/unspecified)

Place of Birth

Town State Country

POLICE USE ONLY

NT Firearms Licence No:

………………..…………………

Fee:……………….….…………

Receipt No:………………..……

Date: .......... / …..…... / ….........

mailto:[email protected]



PF446 Ver4.5

Revised 08/20

Have you ever legally changed your name? Yes No If yes, provide details below

Have you ever been known by another name (not including

legal name changes)? Yes No

If yes, provide details below

Previous / Other Name (if applicable) Surname Given Name Type of change (Deed poll, marriage, alias, etc.)

Section 6: Licence Details

Licence Details

Drivers Licence Number: ……………………………….……….

State…………………..... Expiry........... / …........... / …..........

Interstate Firearms

Licence Number: ……………………………………………..

State…………………. Expiry........... / …........... / …............

Section 7: Contact Details

Contact Details

Home Phone Number:

Work Phone Number: Mobile Phone Number:

Email:

Section 8: Address Details

Current Address Details

Residential: Post Code

Postal: Post Code

You MUST provide proof of address e.g. drivers licence, proof of age card or electoral enrolment or letter from employer (Not more than twelve months old)

Section 9: Address whilst in the NT (Applicable to Interstate Applicants only)

Address details whilst in the NT

Residential: Post Code

Postal: Post Code

Section 10: Business / Employment Details

Business / Employment Details

Your Occupation / Business: Business / Employer Name:

Business / Employer

Phone Number:

Business / Employer

Mobile Number:

Business / Employer Address (Not PO Box): Post Code

Business / Employer Postal Address: Post Code



PF446 Ver4.5

Revised 08/20

Section 11: Storage and Safe Keeping of Firearms *see note Please tick appropriate box or boxes (as applicable)

Storage details

Self-storage (Category A and B (C, D & H if previously inspected))

(Attach PF491 – Self Declaration for ‘Storage and Safekeeping’ of firearms, along with photos of your gun safe)

Self-storage (Category C and H) (Attach PF482 - Permission to Inspect Premises (if not previously inspected))

Storage with the dealer / another licence holder / firearms club (Attach PF492 – Permission to Store Firearms Notice)

*Note – All applicants must have their own storage facility or have access to an approved storage facility and provide supporting evidence. If you have your

own storage facility, you MUST attach photos of the gun safe along with ‘Self-Declaration’ – PF491 form.

Section 12: Permission to Shoot *see note Please tick appropriate box or boxes

Permission to Shoot Details

Crown Land Hunting Permit

(Attach permit from Department of Planning and Infrastructure)

Permission to Shoot on Rural Land

(Attach letter from the landowner – for details of requirements

please read the instructions)

Approval from traditional owner to hunt on Aboriginal land (Attach permission letter from relevant Land Council /

Community on a letter head)

Other NT Government Issued Permits

(e.g. ‘Water Fowl’ or ‘Pig’ Hunting Permits)

Sports Shooting

(Attach ‘Club Certificate of Support / Club Membership PF474’)

Other reasons (Provide details)……………………………………

*Note – All applicants must establish a genuine reason to shoot, with each application and should provide one or more of the above. Refer to instructions.

Provide supporting documentation justifying the reason.

Section 13: Firearms details *see note

Particulars of Firearms for which permit is required

Category

Make / Brand Model

Serial

Number

Action

Type

Calibre (e.g. 300 Win Mag)

Capacity Barrel

Length (Cat H only)

*Note – Refer to instructions attached for more information and examples on how to complete the firearms list above. Attach a separate table if you need to

provide details for more firearms.

Section 14: Information Disclosure Please Tick appropriate boxes



PF446 Ver4.5

Revised 08/20

Information Disclosure

Applicants must answer all the questions (including First Time Applicants)

If previously licensed, this section refers to the period since the issue of your last licence.

Failure to disclose information may result in refusal of this application.

Since your last application under the NT Firearms Act, or for a first time applicant, have you been

listed as a defendant in an interim or final (confirmed) Domestic, Personal or Apprehended Violence Order

(DVO, PVO, AVO) or other similar restraining orders, including interstate and overseas?

Yes No

Since your last application under the NT Firearms Act, or for a first time applicant, have you had a

finding of guilt against you, for any offence, not including minor traffic offences, including

- Any interstate or overseas findings of guilt.

- A finding of guilt not proceeding to conviction.

- A finding of guilt acquired whilst under the age of 18 (youth offences).

Yes No

Since your last application under the NT Firearms Act, or for a first time applicant, have you ever

been diagnosed with a mental health disorder e.g. chronic depression, post-traumatic stress disorder?

If yes, please provide a report from your treating General Practitioner in support of your application.*see note

Yes No

Since your last application under the NT Firearms Act, or for a first time applicant, have you

threatened or attempted self-harm?

If yes, please provide a report from a psychiatrist in support of your application.*see note

Yes No

*Note – The medical reports must state that the treating doctor or psychiatrist “does not consider the applicant a risk to themselves or

others if granted a firearms temporary permit”.

Section 10: Privacy Disclaimer and Declaration

Privacy Disclaimer

Privacy Disclaimer: Northern Territory Police Fire and Emergency Services (NTPFES) is collecting information from your

application to ensure compliance with legislation and to support related processes. This collection is authorised and

required by the NT Firearms Act and Regulations. Through national agreements the NTPFES will provide some or all of

this information to other agencies with an interest in firearm permits, licensing, and registrations. Failure to provide this

information in full or in part may result in your application not being processed or being refused.

You can access your personal information provided on this form. If you have any queries or wish to access this information

please contact NTPFES by phoning 08 8999 5511 (NT Government Switch).

Declaration

I solemnly and sincerely declare that the above particulars contained in this application are true

and correct. I make this application under the Firearms Act and acknowledge to make a false

statement in an application is an offence under Section 89 of that Act.

Applicant’s Signature:................................................................... Date: ....... / ........ / ................

Applicant’s Name: ………………………………………………………….……………………………

Declared at

(Police Station):

..........................................

PENALTY: 100 PENALTY UNITS OR IMPRISONMENT FOR 2 YEARS FOR FALSE OR MISLEADING STATEMENTS

– Firearms ownership is not a right, it’s a responsibility –

RECEIVING MEMBER – See overleaf to complete application

Temporary Permits Page 5


PF446 Ver4.5

Revised 08/20

WRITTEN FIREARMS SAFETY EXAMINATION - POLICE USE ONLY

Completed and attached

Not Completed – Reason Renewal Interstate Transfer

Holds current NT FTSC (Firearm Training Safety Certificate)

{NOTE – Valid for 5 years from date of issue}

New Photograph taken (email to: [email protected]) NOTE: Supporting documentation must be attached

Application updated on SAFER Yes No If No reason: ……………………………………………………………………………………

CHARACTER / CONVICTION - POLICE USE ONLY

PROMIS check completed

(by member receiving application)

Unknown – New PROMIS ID: ................................................

Known – PROMIS ID’S list all:……………...…………..…….……….

Criminal / Traffic History: No Yes

If yes: Not relevant (old / minor / not criminal)

Relevant, Attach printout of details

Involvements: No Yes

If yes: Not relevant (old / minor / not criminal)


Alerts / Warrants / DVO’S: No Yes

If yes Not relevant (old / minor / not criminal)


IJIS check completed (by member receiving application)

Unknown

Known – IJIS ID:……………....………..…..…..………………....

Criminal / Traffic History: No Yes



Domestic Violence Orders Personal Violence Orders Restraining Orders

No Yes

If yes Not relevant (more than 6 years old)

Relevant (less than 6 years old). Attach printout of details

Other History / Orders No Yes



NFLRS check completed (if required) (Interstate Licence Transfer)

Current Expired

Not relevant


Interstate Firearms Registered No Yes

If yes No Outstanding Firearm(s) – supplied Transfer Permits for all

Yes Outstanding Firearm(s), Attach printout of details/declarations

NPRS check completed Known unknown

Not relevant


RECEIVING MEMBER TO COMPLETE Signature of member receiving application: Name, Position / Rank (printed): Reg. No.: Date Received

.................................................................... .................................................................................................. ............................ ….…./…..…../…..…..

All applications must be commenced on SaFER before scanning and emailing to the Firearms Policy and Recording Unit.

All original applications must be retained at the receiving station. Incomplete applications will be returned for action.

FPRU USE ONLY

APPROVED NOT APPROVED Reason Category: ............... ............... ............... Reason Code: ............. ...............

Condition Codes: ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............

Signature: ..................................................................................... Position/Rank: ................................................. Date: ............./............. / ...............

FOR POLICE USE ONLY Forward to the FPRU, DARWIN. Tel: 131 444 Fax: 08 89223540 Email: [email protected]

For more information visit: http://www.pfes.nt.gov.au/Police/Firearms-Weapons/Firearms-licences-permits-forms.aspx

mailto:[email protected]

http://www.pfes.nt.gov.au/Police/Firearms-Weapons/Firearms-licences-permits-forms.aspx

Documents

Application for Firearms Temporary Permit · finding of guilt against you, for any offence, not including minor traffic offences, including - Any interstate or overseas findings of