regulation gazette, no. 7926...persal number of wltness 9.4 ..... signature of witness page4of 6 152...

150 NO. 261 56 GOVERNMENT GAZETTE, 26 MARCH 2004

SAPS 517(e)

* I DETAILS OF FIREARM LICENCE(S) TO BE RENEWED A

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:J::

Page3of 6

STAATSKOERANT, 26 MAART 2004 No. 26156 151

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SAPS 517(e)

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..................................................................................................................................................................................................

I DECLARATIONBY APPLICANT I I am aware that it is an offence in terms of section 120 (9)(9 of the Firearms Control Act, 20M) (Act No 60 of ZOOO), to make a false statement in this application.

Note:

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

- The background of the photo must be plain. - The applicant may not be wearing a hat or sunglasses on the

- The applicant's name and identification number must be written

applicant.

photograph.

on the back of the photograph before it fs affixed on the application form.

- The applicant must sign in black ink. - The signature may not exceed the border.

- The fingerprint should not be rolled and must be a flat impression. - The whole finger must be pressed down on the sheet.

....... : , . . . . . : i

. . . .

2 :

PHOTO

: r .............................................................

.........................................

Fingerprint designation . . . . . .

: :. . . . . . . . . . . . , . . . r

. .

. . . . . . . . . . . . . . . : .. .......................................................................................................................................................................................................

Signature : ;

I PARTICULARS OF POLICE OFFICIAL DEALING WITH AP'PLICATION I

*" II Name of police official in block letters

B'3 II Rank of po1ic:e official in block letters

8.2

Persal number of police official

0.4 ................................................................. Signature of police official

I PARTICULARS OF WITNESS I

Name of wkness in block letters

9.3 i I Rank of witness In block letters

9.2 1 Persal number of wltness

9.4

................................................................. Signature of witness

Page4of 6

152 No. 261 56 GOVERNMENT GAZETTE, 26 MARCH 2004

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SAPS 517(e)

Signature of interpreter

LI Rank of police official in block letters (if applicable)

16

Persal number of police official (if applicable)

Page 5 of 6


SAPS 517(e)

.....................................................................................................................................................

. . ..................................................................................................................................................................................................

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1 Rank of Designated Firearms Offw/Station Commissioner in block letters

I)

................................................................... Signature of Designated Firearms Officer/Station Commissionlgr

8 1 Penal number of Designated Firearms Officer/Station Commissioner

Page6of 6

154 No. 261 56 GOVERNMENT GAZETTE, 26 MARCH 2004

SAPS 51 7(9

SOUTH AFRICAN POLICE SERVICE

APPLICATION TO DECLARE PREMISES A FIREARM FREE ZONE Section 140 of Ihe Firearms Control Act. 2000 (Ad No 60 of 2000)

OFFICIAL DATE STAMP ~~~~

DATE RECEIVED

I ’ Declared a Firearm Free Zone I SAPS Head Office reference no

I Government Gazette reference no I

Page 1 of 4

STAATSKOERANT, 26 MAART 2004 No. 261 56 155

SAPS 517(f)

15

15.1

16

17

18 Conditions

- The premises declared a Firearm Free Zone must be clearly identified and demarcated.

- Signs must be erectedlposted at all the main entrances to the premises in English and where applicable in the predominant local language and maintained.

- A map of the premises which already specify the demarcated area and sign must be attached to the application.

- The institution where premises are declared Firearm Free Zone must endeavour to mark all correspondence accordingly to reflect the premises firearm free status.

- The person applying on behalf of the Institution must notify the Designated Firearms Officer responsible for the area of any changes that may occur to any information submitted in this application.

Name of applicant in block letters

21

Signature of applicant

Page2of 4

156 No. 261516 GOVERNMENT GAZETTE, 26 MARCH 2004

1

1

- J

I) Rank of Designated Firearms Officer

.................................................................. Signature of Designated Firearms Omcer

8 1 I I I I I I - I I Persal number of Designated Firearms Ofticer

LI Name of Station Commissioner in block letters

3 Rank of Station Commissioner in block leffers

.................................................................. Signature of Station Commissioner

7 I I I I I - I I Penal number of Station Commissioner

.................................................................................................................................................................................................. I I

Name of Provincial Commissioner in block letters

4

.................................................................. Signature of Provincial Comm!ssioner

I 1 - 1 I 1 - 1 I J

Page 3 of 4


Name of National Commissioner in block letters

4 .................................................................. Signature of National Commissioner

I - tn I

Name of Secretary of Safety and Security in block letters

4 ................................................................. Signature of Secretary of Safety and Security

I I 1 - 1 7

3 .................................................................. Signature of Minister of Safety and Security

I

as one should go to the applicant, one should and one should be forwarded to Head Office

Zone declaration.

Page 4 of 4


SAPS 51 8


APPLICATION FOR A TEMPORARY AUTHORIZATION TO POSSESS A FIREARM Section 21 oflhe F i r s a n s Control Act. 2000 (Act No 60 of 2000)

I DATE RECEIVED I

I I

1 I I I ........ I 'I Name in block letters

.......... r m I 1 ........................................................ L-J I I Signature of deciding officer '' Officer code 'I Name in block letters

I ........ I

......................................................... I '6 Signature of deciding officer Officer code le Name in block letters I

Page 1 of 8

STAATSKOERANT, 26 MAART 2004 No. 261 56 159 -

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22

DETAILS OF FIREARM (Indicate with an X )

Action

Firearm component type:

I OTHER BODIES (eg body corporate, close corporation or company) 1

160 NO. 261 56 GOVERNMENT GAZElTE, 26 MARCH 2004

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I DECLARATION BY PERSON WHO IS LAWFULLY IN POSSESSION OF THE FIREARM

I hereby declare that the above firearm is legally in my possessimon and that I propose to supply it to the applicant once the necessary authorization has been obtained and that the particulars of the firearm is correct and accurate.

I R E OF PERSON CURRENTLY IN POSSESSION 1 1

Name of per:ion currently in possession in block letters

. . . - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Signature of person currently in possession

I NATURAL PERSON'S DETAILS

I Type of identification (Indicate with an X)

Page3of 8

STAATSKOERANT, 26 MAART 2004 NO. 261 56 161 e__

24 JURISTIC PERSON'S DETAILS

SAPS 51 0

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1 Period for which authorization is required

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3.1

3.3

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3.8

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Fage 4 of 8

162 No. 261 516 GOVERNMENT GAZElTE, 26 MARCH 2004

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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - ............... - ............................................................................................................................... I

L ................ ~

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Page5of 8

STAATSKOEiRANT, 26 MAART 2004 No. 26156 163

SAPS 518 10 I DECLARATION BY APPLICANT I

I am 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 in this application.

Note:


- The photograph must be in colour and may not exceed tile border.

- The photo must be a full front view of the head and shoLllders of the - The photo must be the size of a standard passport photograph.


- The applicant's name and identification number must be W'tten

applicant.

photograph.

on the back of the photograph before it is affuted 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.

8

8.1

8.3

9

9.1

9.3

1

2

............................................................................................................... Signature

J Name of applicant in block letters

PHOTO

...... ..... .,.., .. .,.. . . . . . . . . . . . . . . . . . . . .

.................... .....l..................................

Fingerprint designation r-

1

.... , ........... ... ....,..... .. ...._..., ...........

3

I -m /' I

l Name of police ofiicial in block letters

8.2

Persal number of police official

c 8.4 I I Rank of police official in block letters

................................................................. Signature of police official

PARTICULARS OF WITNESS , Name of witness in block ietters 9.2

Persal number of witness

9.4

................................................................. Rank of witness in block letters Signature of witness

c

Page6of 8


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2.1

..... _.._ .......................... ~ ............................. Signature of interpreter

EI Rank of police officer in block letters(if applicable)

16 I I I I I - I I Persal number of police offcial(lf applicable)

~ ...______..._.. Signature of pwenUguardian

STAATSKOERANT, 26 MAART 2004 No 26156 165

...............................................................................................................................................................................................

Name of Designated Firearms OmcerlStation Commissioner in Iblock letters .................. ...... .............. ,,.. , ....,....... _. ....,. ...... ,. :... ......,....... .:<... 3E(g&.ggz ........ .......................... I

Rank of Designated Firearms Officer/Station Commissioner in b'lock letters

1 .................................................................. Signature of Designated Firearms Officer/Station Commissioner

8

Persal number of Desianated Firearms OfficdStation Commissioner

Page 8 of 8


. ’ !

CONTINUES ON PAGE 17O-PART 2

261 56-4

Government Gazette

REPUBLIC OF SOUTH AFRICA

Regulation Gazette No. 7926

Vol. 465 Pretoria 26 March 2004 No. 26156

AIDS HELPLINE: 0800-0123-22 Prevention is the cure

PART 2 OF 4


SAPS 518(a)

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1.2

1.3

1.4

1.5

1.6

1.7

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APPLICATION FOR THE RENEWAL OF A FIREARM LICENCE, PERMIT, CERTIFICATE OR AUTHORIZATION

Section 24,35, 49 and 63 o:'the Firearm Control Act, 2000 (Act No 60 of 2000)

P- Application reference No

I DATE RECEIVED 1

Page 1 of 5


SAPS 51 8(a)

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f NATURAL PERSON’S DETAILS I I d e n t i f i c a t i o n (Indicate with an X) I

I JURISTIC PERSON’S DETAILS J

I OTHER BODIES 1

* Proof of pelmanent residence must be submitted if an applicarlt is not a SA citizen.

Page 2 of 5

172 NO. 2615'6 GOVERNMENT GAZETTE, 26 MARCH 2004

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40

I OTHER INFORMATION (indicate with an x) 1

Page 3 of 5

STAATSKOERANT, 26 MAART 2004 No. 261 56 173 ~

S

E

8.1

8.3

9

9.1

9.3

1

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5

SAPS 5iB(a)

NO:*:


- 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


- The applicant's name and identification number must be written

applicant.

photograph.

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. - Tho fingerprint should not be rolled and must be a flat impression.

....

2 :

............................................................ ., ........................................ Signature

PHO' TO

' .

i! Fingerprint designation

3

...... 1

........... ...... ......... I

Name of applicant in block letters

I PARTICULARS OF POLICE OFFICIAL DEALING WITH APPLICATION I 1 Name of police official in block letters

II Rank of police official in block letters

1 PARTICULARS OF WITNESS

I( Name of witness in block letters

8.2 I I Persal number of police ofkiai

0.4

......................................... Signature of police official

9.2 I I I 1 - 1 1 Persal number of witness

Id Rank of witness In block letters

9.4

................................................................. Signature of witness

Page 4 of 5


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.................................................................. Signature of interpreter ' Rank of police official in block letters(if applicable)

(4 ;:,*:::>:::::,>:,$* :::<e@+g;F ............. ri:, ........,,..,. .... ............................. x, 1

16 1 - 1 1 Persai number of police official (if applicable)

................ : ...... ;: J ~~?:i:;~i:~:~::.:.:.: ..... :::.&$+$$$$;

.:.:. ............ ..: ...............

I:;i"."'~,~;$<i~:~ :::ej@@E .................................. ................... ...................................................................

I I

Name of Designated Firearms OfficerIStation Commissioner in block letters

L J

Rank of Designated Firearms Officer/Station Commissioner in block letters

6

.................................................................. Signature of Designated Firearms Officer/Station Commissiorler

I I I I I I I I - I I Persal number of Desianated Firearms Offcer/Station Commissioner

Page 5 of 5

regulation gazette, no. 7926...persal number of wltness 9.4 ..... signature of witness page4of 6 152...

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