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
//
//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