Firearms Act 2015 & Firearms Regulations 2017APPLICATION for VARIATION / ADDITION / REVOCATION of LICENCE CATEGORIES / FIREARM CATEGORIES / LICENCE CONDITIONS

APPLICANT

Residential or if Company,Business Address

Postal Address (If different)

Telephone Numbers

Email Address

Home

Mobile

Date of Birth

Occupation

Sex

PENALTIES may apply for FALSE STATEMENTSLicence / Permit No.

PD307

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//Expiry Date

ABN

I wish to vary my licence by:

Revised: 5/12/2018 Page 1 of 2

AVL

Surname

First Name Middle Name(s)

Licence Category

Firearm Category

1 - S

hoot

ing

Clu

b

2 - T

arge

t Sho

otin

g

3 - H

untin

g

4 - P

aint

ball

Shoo

ting

5 - P

rimar

y Pr

oduc

tion

6 - S

ecur

ity G

uard

7 - C

ontra

ct S

hoot

er

8 - C

omm

erci

al R

ange

9 - S

hoot

ing

Gal

lery

10 -

Col

lect

or

11 -

Dea

ler E

mpl

oyee

12 -

Mis

cella

neou

s

Category 11 (Dealer) licence to be varied for on RF1637. Note: Where appropriate, please forward any required justification or documentation with this application For miscellaneous, provide details, including if for imitation only.

A

B

C

D

H

P

Z

VARIATION REQUIRED (ONLY place 'A' for addition, or 'R' for removal, in appropriate box)

Firearm type per category

A Air gun, paint-ball firearm, rim fire rifles (not self-loading), shotgun (not self-loading or pump action), break action combination shotguns and rim fire rifles.

BMuzzle loading firearms (not handguns), revolving chamber rifles, centre fire rifles (not self-loading), multiple barrel centre fire rifles that are not designed to hold additional rounds in a magazine; break action combination shotguns and rifles, all other firearms (not being prescribed, handguns, self-loading firearms or pump action shotguns) that are not category A firearms.

C Self-loading rim fire rifles having a magazine capacity of 10 rounds or less, self-loading or pump action shotguns having a magazine capacity of 5 rounds or less.

D Self-loading rim fire rifles having a magazine capacity of more than 10 rounds, self-loading centre fire rifles, self-loading or pump action shotguns having a magazine capacity of more than 5 rounds.

H All Handguns (not being prescribed)P Prescribed Firearm as per section 5 and regulation 7Z Ammunition only

Address where firearm(s) is to be secured

POSTCODE

POSTCODE

NON REFUNDABLE application fee applies

PD307Revised: 5/12/2018

The reason(s) for requiring variation to categories, limitations or condition(s) is / are as follows:

Page 2 of 2

APPLICATION for VARIATION / ADDITION / REVOCATION of LICENCE CATEGORIES/ FIREARM CATEGORIES / LICENCE CONDITIONS

SOUTH AUSTRALIA POLICE

MUST ATTEND A LOCAL POLICE STATION WITH 100 POINT OF IDENTITY

(Date)

//(Signature of Applicant)

I hereby declare that all particulars given by me in this application are true and correct.

DECLARATION

LOCAL POLICE STATION USE ONLYProof of identity, age and address produced (100 point system MUST be met) - Copies must be attached

POLICE

STATION

STAMP

POLICE RECOMMENDATION: Not Recommended (Attach brief report)Recommended

SAPOL Employee's Signature:

Print Name:

ID No.:

Police Station Code:

Rank/Class:

Date:

Variation Application Fee: $ SAPPOS Receipt No.:

FORWARD TO FIREARMS BRANCH (130)

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APPLICATION FEE IS NON REFUNDABLE