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B. RESIDENTIAL ADDRESS - minor

Application for a Minor's Firearm Permit

P637NSW POLICE FORCE - FIREARMS REGISTRY

This is an interactive form. Please complete the sections, print & sign this form and submit with the Minor's Firearm PermitLegitimate Reason form to the Firearms Registry, Locked Bag 5102, Parramatta NSW 2124. Fields in RED are mandatory.

The applicant must be a minimum of 12 years of age, but no older than 18 years of age.

This application requires the consent of the parent or legal guardian of the applicant. Consent is provided on the Minor'sFirearm Permit Legitimate Reason form, which must accompany this application.

If you wish to make application for a Minors Safety Training Permit (AB or C) and a Minors Target Pistol Permit (H), you may doso on the one application, but you will need to pay two fees.

ABN 43 408 613 180

Day TimePhone No

If you have been known by another name, please provide details below (Last Name, Given Names)

Last Name

NSW DriversLicence No.

A. NOMINATED PERMIT HOLDER - minor

Date of Birth

Gender

C. POSTAL ADDRESS - If the same as your residential address please mark this box

EmailAddress

MobilePhone No

You may select:1. A Firearms Safety Training Permit for Categories A & B, or2. A Firearms Safety Training Permit for Category C (supported by evidence of physical need), or3. A Minor's Target Pistol Permit for category H, or4. Both a Minor's Target Pistol H and a Firearms Safety Training Permit AB or C.

If you apply for both the Target Pistol and the Firearms Safety Training Permit, two fees will apply.

An application for a Category C Permit for clay target shooting must be accompanied by proof of membership of a clubaffiliated with the Australian Clay Target Association or other body approved by the Commissioner of Police and must also besupported by evidence from a medical practitioner of the physical reason for needing a pump action or self-loading shotgunfor Clay Target Shooting. Please see the Legitimate Reason form for the specific requirements relating to a Category C MinorsPermit.

Fees: Should you wish to apply for a Minor's Safety Training Permit and a Minor's Target Pistol Permit, a separate fee of $75.00is required for each permit.

D. PERMIT TYPE This application is for a (please select)

First andMiddle Names

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F. DECLARATION - must be completed by the applicant (the minor) · 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.

Applicants Signature Date

E. 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) Have you 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

G. FEEPlease attach a cheque or money order made payable to the 'NSW Police Force' or complete the credit card authority below.Remember, one permit is $75 and if you make application for two permits, then you must pay two fees = $150

Please debit my for Card Number

CardholderName

CardholderSignature

YearExpiry Month

OFFICE USE ONLY

Receipt No. Amount Date$