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SAPS 271Page
1 of 12
SOUTH AFRICAN POLICE SERVICEA
PPLICATION 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 STAMPA.
FOR OFFICIAL USE BY THE POLICE STATIONWHERE THE
APPLICATION IS CAPTURED Applic
ation reference No 1Number of applicationof2D
ATE RECEIVEDB.
FOR OFFICIAL USE BY POLICE STATION WHERE THE APPLICATION IS RECEIVED1Pr ovince2Are a3Poli ce station4Co mponent code5Fi rearm applications register reference NoSAPS 86NOYEARC. FOR OFFICIAL USE BY THE CENTRAL FIREARMS REGISTER (CFR) Ou tstanding/Additional information required 1-Persal number-- Date23
Signature of police official Name in block letters45 A
pplication 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) for refusal1213-Persal number-- Date1415
Signature of CFR officer Officer code Name in block letters161718SAPS 271Page
2 of 12D.
TYPE OF APPLICATION FOR A LICENCE TO POSSESS A FIREARM(S) M ain firearm licence holder Additional firearm licence holder(Indicate with an X) 1 2 3Sectionnu mberTy pe of licence/permitPeriod ofv alidityX 3.113 Licence to possess a firearm for self-defenceFive years3.214 Licence to possess a restricted firearm for self-defenceTwo years3.315 Licence to possess a firearm for occasional hunting and/or sport-shootingTen years3.416 Licence to possess a firearm for dedicated hunting and/or dedicated sport-shootingTen years3.517 Licence to possess a firearm in a private collectionTen years3. 619Licence to possess a firearm, in a public collectionTen years3.7 20 Licence to possess a firearm for business purposes: Business in huntingFive years3.820 Licence 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 TVpr oductionsTwo years3.1 020 Licence to possess a firearm for business purposes: As a security businessTwo years3.1 120
Licence to possess a firearm for business purposes: For training purposesTwo years3.1 220
Licence to possess a firearm for business purposes: As a game rancherTwo yearsE.
DESCRIPTION OF FIREARM (Indicate with an X)TY
PE OF FIREARM 1Rifl
eShotgunHandgunCombinationOt her, specify (armament/ind eterminable designtyp e)DETAILS OF FIREARM (Indicate with an X) 1.
1A ctionSemi-au tomaticAutomaticManualOther ac tion (specify)1.2Na mes and addresses engraved in the metal1.3Ca libre Calibre code1.41.5M ake1.6M odel Fir earm component type:1.7Ba rrel serial number Make1.81.9Fr ame serial number Make 1.10 1.1 1R eceiver serial number Make1.12F.PARTICULARS OF CURRENT OWNER1T
ype of owner (Indicate with an X)1.2A Pr ivate ownerB Fir earm dealerC C ompanyD Im ported firearmE Est ate2NATURAL PERSON'S DETAILS
SAPS 271Page
3 of 123T
YPE A (Private owner)4Sur
nameInitials 56Ful l names7Ident ity number ---8R esidential addressPostalCode 910Po
stal addressPostalCode 1112Telephone num
ber Home( )Work( )12.112.2 12.3Cellphone num
berFax( )13 14E- mail address15Are there any additional firearm licence holders for this firearm? (Indicate with an X)YESNO16JURISTIC PERSON'S DETAILS17T
YPE B (Firearm dealer)18R
egistered company name19T rading as name20FAR number21Po stal addressPostalCode 2223Bu
siness addressPostalCode 2425Bus
iness telephone numberWork( )Fax( )25.1 25.2 26E- mail address27Re sponsible person (Name and surname)28Ty pe of identification (Indicate with an X)SA citizenNon-SA citizen with permanent residence*29Ide ntity number of responsible person---30Ce llphone number31Ph ysical addressPostalCode 3233Po
stal addressPostalCode 3435SA
P 350 (A) DETAILSFir
earm received from36N ame37Ide ntification number or FAR number38Ad dress39Postal code Date received--40* In case of a non-SA citizen proof of permanent residence must be submitted.SAPS 271Page
4 of 1241T
YPE C (Companies)42R
egistered company name43T rading as name44FAR number45Po stal addressPostalCode 4647Bu
siness addressPostalCode 4849Bus
iness telephone numberWork( )Fax( )49.1 49.2 50E- mail address51Re sponsible person (Name and surname)52Ty pe of identification (Indicate with an X) SA citizenNon-SA citizen with permanent residence*53Ide ntity number of responsible person---54Ce llphone number55Ph ysical addressPostalCode 5657Po
stal addressPostalCode 58
59 TYPE D (Imported firearms)60Im
port permit number61Da te issued--62Ex piry date--63TYPE E (Estate)64Ty
pe of estate (Indicate with an X)65Ex nameInitials 6768Ful l names69Ident ity number of the owner of the firearm---70Na me and surname of executor, administrator, curator, trustee or liquidator71Ty pe of identification (Indicate with an X)Non-SA citizen with permanent residence*SA citizen72Id entity number of executor, administrator, curator, tru stee or liquidator-- -73Telephone num ber Home( )Work( )73.173..2 73.3Cellphone num
berFax( )74 75Ph ysical address Posta lCode 7677Po stal addressPostalCode 78*
In case of a non-SA citizen proof of permanent residence must be submittedSAPS 271Page
5 of 1279Phy
sical address where firearm(s) is keptPostalCode 8081
DECLA RATION 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 thene
cessary licence(s) has/have been obtained and that the particulars of the firearm(s) are correct and accurate.I a
m 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
application.82Na me and surname of current owner/authorized person83Ide ntification number of current owner/authorizedpe rson-- -84De signation85D ate--86 87PlaceSign ature of current owner/authorized personG. PARTICULARS OF APPLICANT (Complete only the section that has bearing on you.)1P ARTICULARS OF EXISTING COMPETENCY CERTIFICATE (Indicate with an X)1.1A
Competency certificate to trade in firearms1.2B
Competency certificate to manufacture firearms1.3C Competency certificate to conduct business as a gunsmith1.4D Competency certificate to possess a firearm (Indicate with an X)Ha ndgunRifleShotgun1.5Co mpetency certificate number1.6D ate of issue-- Expiry date--1.72DET AILS OF FIREARMS IN YOUR POSSESSION AND FOR WHICH YOU HAVE A LICENCE, PERMIT OR AUTHORIZATION TypeCalibreMakeBarrel Serial NoFrame/receiver Serial2.1NoLice nce/permitauthorizat ion NoSAPS 271Page
6 of 12
3NATURAL PERSON'S DETAILS
4PRIVA
TE PERSON
5T ype of identification (Indicate with an X)5.1SA citiz enNon-SA citizen with permanent residence*Identity number of private person---67Sur
name Initials8 Fu ll names9Date of birth-- Age GenderMaleFemale10111213R
esidential address Posta l Code1415Po stal address Posta l Code1617Ty pe of residence (eg shack, flat, caravan, cottage, house, hostel or homeless)18Tr ade or profession If self-employed, specify1920Na me of employer/company21Bu siness address Posta l Code2223Telephone num berHome( )Work( )23.1 23.2 23.3Cellphone num
ber Fax( )24 25E- mail address26M arital status (Indicate with an X) Sin gleMarriedDivorcedWidowWidower27Other (spe cify)* In case of a non-SA citizen proof of permanent residence must be submittedSAPS 271Page
7 of 1228PA
RTICULARS OF APPLICANT'S SPOUSE/PARTNER
29Type of identification (Indicate with an X)29. 1SA
IDPassport30Id
entity number of spouse---Passport number of spouse3132N
ame and surname33JURISTIC PERSON'S DETAILS
34OTHER BODIES (eg body corporate, close corporation or company)
Registered company name 35
Trading as name36 FAR
number37 P ostal address38 Posta l Code39 B usiness address40 Posta l Code4142Bus iness telephone numberWork( )Fax( )42.1 42.2 43E- mail address44N umber of firearms already registered to the business45N umber of persons employed by the business to handle firearms46Re sponsible person (Name and surname)47Ty pe of identification (Indicate with an X)SA citizenNon-SA citizen with permanent residence*48Ide ntity number of responsible person---49Ce llphone number50Ph ysical address Posta l Code5152Po stal addressPostalCode53 54OT
HER DETAILS (Applicable to dedicated hunters, dedicated sports-persons or collectors only.)55Areyou a member of an accredited association? (Indicate with an X)YESNOIf yes, submit the following details56State
name of accredited association57FAR number of accredited association58M embership numberDate joined--59 Ex piry date--60 Motivation of purpose for which the firearm is required (Applicable to all types of applications)61* In case of a non-SA citizen proof of permanent residence must be submittedSAPS 271Page
8 of 12HA
VE YOU EVER BEEN CONVICTED OF AN OFFENCE COMMITTED INSIDE OR OUTSIDE THE BORDERS OF THE RSA? 62 (Indicate with an X)YES
NOIf yes, submit the following detailsPoli
ce station CAS/Case number62.1(1) 62.2 Ch arge62.3O utcome62.4Poli ce station CAS/Case number62.5 (2) 62.6 Ch arge62.7 O utcome62.8A RE THERE ANY CASES PENDING AGAINST YOU? (Indicate with an X)63YESNOIf yes, submit the following detailsPoli
ce station CAS/Case number63.1(1) 63.2 Of fence63.3Poli ce station CAS/Case number63.4(2) 63.5 Of fence63.6HA VE ANY OF YOUR FIREARM(S) EVER BEEN LOST/STOLEN? (Indicate with an X)64 YESNOIf yes, submit the following detailsPoli
ce station CAS/Case number64.1(1) 64.2 Cir cumstances64.3Detail s of firearm64.7Poli ce station CAS/Case number64.5(2) 64.6 Cir cumstances64.7Detail s of firearm64.8WAS A CASE OF NEGLIGENCE OPENED AND INVESTIGATED REGARDING THE STOLEN/LOST FIREARM? (Indicate with an X)65 YES
NOIf yes, submit the following detailsPoli
ce station CAS/Case number65.1(1) 65.2 C hargeOutcome65.3 65.4 Poli ce station CAS/Case number65.5(2) 65.6 C harge Outcome65.765.8 H AVE YOU EVER BEEN DECLARED UNFIT TO POSSESS A FIREARM? (Indicate with an X)66YESNOIf yes, submit the following detailsPoli
ce station CAS/Case number66.1(1) 66.2 Ch arge66.3Da te from Period66.466.5 Poli ce station CAS/Case number66.6(2) 66.7 Ch arge66.8Da te from Period66.966.10 HA S A FIREARM IN YOUR POSSESSION BEEN CONFISCATED? (Indicate with an X)67 YESNOIf yes, submit the following detailsPoli
ce station CAS/Case number67.1(1) 67.2 C ircumstances Outcome67.367.4SAPS 271Page
9 of 12Poli
ce station CAS/Case number67.5(2) 67.6 C ircumstances Outcome67.767.8 68DO YOU HAVE THE PRESCRIBED SAFE? (Indicate with an X) YES NO68. 1IF Y ES, SUBMIT FULL DETAILS (Indicate with an X, with short description)Ty pe of safeHandgunRifleStro ngroomD evice69IS
SAFE MOUNTED? (Indicate with an X) YE
SNO69.
1IF YES, SUBMIT FULL DETAILS (Indicate with an X)W
allFloor70 DECLARATION BY APPLICANTI a
m 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
application.H . SIGNATURE OF APPLICANT (Sign only if applicable) No te:The requirements of the photo:- The photograph must be in colour and may not exceed the border. - The photo must be the size of a standard passport photograph.- The photo must be a full front view of the head and shoulders of the applicant.-The background of the photo must be plain.-
The applicant may not be wearing a hat or sunglasses on the photograph.- The applicant's name and identification number must be written on the back of the photograph before it is affixed on the application form.-The applicant must sign in black ink.-
The signature may not exceed the border.-
The whole finger must be pressed down on the sheet.- The fingerprint should not be rolled and must be a flat impression.PHOTO 1 Fin gerprint4 designation3 2Signature5
Date-- 6 Nam
e of applicant in block letters 7 Pl aceSAPS 271Page
10 of 128PA
RTICULARS OF POLICE OFFICIAL DEALING WITH APPLICATION8.1 8.2- Name of police official in block letters Persal number of police official8.3
8.4Rank of police official in block letters Signature of police official
9PARTICULARS OF WITNESS9.1
9.2- N ame of witness in block lettersPersal number of witness9.3 9.4Rank of witness in block letters Signature of witnessI.
PARTICULARS OF INTERPRETER (
This section must be completed only if the applicant cannot read or write or does not understand the content of this form.)1Na
me and surname of interpreter2Ide ntity/Passport number of interpreter3R esidential address Posta l Code 45Po stal addressPostalCode6 7Telephone num
ber Home( ) Work( )7.17.28Cellphone num ber Fax( )910E- mail address11In terpreted from (language)to12D ate--13 14Pl aceSign ature of interpreter15 16- Rank of police official in block letters (if applicable) Persal number of police official (if applicable)J.
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