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Vers 3.0 October 2019
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F. SAFEKEEPING ADDRESS OF FIREARMS This section MUST be completed by all applicants even if you do not
currently possess any firearms.
H. DECLARATION
• I fully understand and can comply with the firearms safekeeping requirements of the Firearms Act 1996 and associated Regulation.
• I understand that it is a serious offence under the Firearms Act 1996 to make a statement or provide information that I know is false or
misleading & I certify that all the information contained in this application is true and correct in every detail
.
• I authorise the release of my personal information to any third party the Commissioner deems appropriate and for the purposes of
any relevant Authority verifying the details of this application.
• I agree to the NSW Police Force undertaking such enquiries as are necessary to establish that the information I have provided in
relation to this application is true and correct.
Applicant's Signature Date
Name of NSW Club or Person
Storing firearms (if applicable).
G. PERSONAL HISTORY - You MUST complete this section - select one box for each question
IF YOU ANSWERED YES TO ANY OF THE ABOVE QUESTIONS, PLEASE PROVIDE DETAILS AS AN ATTACHMENT
c) Been subject to a firearms/weapons prohibition order?
a) Been refused or prohibited from holding a firearms licence or permit or had a firearms licence or permit
suspended, cancelled or revoked?
d) Ever attempted suicide or self harm, or in the past 12 months been referred or treated for alcoholism,
drug dependence, or a mental or nervous disorder or illness?
e) Within the last 10 years, been convicted of an offence involving firearms or weapons, prohibited drugs/ plants/
prescribed restricted substances, fraud/dishonesty/stealing, terrorism, violence, assaults against law
enforcement officers, robbery, organised criminal groups and recruitment, riot, affray or an offence of a
sexual nature or are you presently subject to a good behaviour bond in relation to one of those offences?
Have you in NSW or elsewhere;
b) Been recorded as a registrable person or corresponding registrable person under the Child Protection
(Offenders Registration) Act 2000?
f) Within the last 10 years, been the subject of a Apprehended Violence Order (other than an order which was
revoked) or an injunction ordered by the Family Court, or presently subject to an interim Apprehended
Violence Order?
YES/NO
I. FEE - Please attach a cheque or money order made payable to NSW Police Force or complete the credit card authority
below for the amount as specified in the applicable legitimate reason form.
Please debit my for $
Card Number
Expiry
Date
Cardholder
Name
Cardholder
Signature
YearMonth
OFFICE USE ONLY
Receipt No. Amount Date
The Firearms Act 1996 prescribes strict requirements for the safekeeping of firearms. Failure to comply attracts severe penalties.
See Safe Storage FACT Sheets available on the 'Safe Storage' page on the Firearms Registry internet site.
Overseas competitors please insert the details of the storage address for the firearms while in NSW.
Provide additional details, as an attachment, if your firearms are stored at more than one location.
If the safe storage address is the same as the residential address mark this box If 'NO', complete details below.
Storage Address
$
Mastercard / Visa
