I, Family name

Given name(s)

being the representative endorsed on the approved shooting club permit of,

Name of sports or target shooting club

Contact no.Club approval number

Mobile

hereby declare that: Applicant’s current membership number

• The applicant’s current membership number with the club is

Joining date of membership Expiry date of membership

Day Month Year Day Month YearAND• The applicant was previously an interstate or overseas shooter who has complied with section 18B(3) of the

Weapons Act 1990;

Licence/Permit No.

State/Country

Joining date of membership Expiry date of membership

Day Month Year Day Month YearAND• The applicant has provided the attached documentary evidence from his/her interstate/overseas club to

support this application; i.e. copy of interstate/overseas licence/permit;AND• The information contained in this document is true and correct to the best of my knowledge.

Signature of representative Day Month Year

QUEENSLAND POLICE SERVICEApproved Club Declaration (Interstate/Overseas Applicant)

To accompany an Application for aConcealable Firearms Licence for sports or target shooting

QuEENSLANdWeapons Act 1990

Section 18BQP 0518B

02/13∆1

This declaraTion is valid for 28 days afTer iT is siGned By The aPProved PisTol clUB rePresenTaTive

Details of the applicant for a licence for the purpose of sports or target shooting.

Lot on Plan (RP No.) can be found on rates notice.

1. APPLICANt DEtAILSFamily name

Given name(s)

Property name/ Lot on plan

Street number and name

Suburb/Locality

State Postcode

date of birth

Day Month Year Signature of applicant

2. SPORtS OR tARGEt SHOOtING CLUB REPRESENtAtIVE DECLARAtIONDeclaration of Shooting Club Membership by endorsed representative.

Details of Interstate/Overseas membership.

endorsed representative to sign and date declaration.

QP 0518B Approved Club declaration (Interstate/Overseas Applicant) To accompany an Application for a Concealable Firearms Licence for sports or target shooting Page 1 of 1