"Application for Renewal of Individual Firearm License" - Pampanga, Philippines

This fillable "Application for Renewal of Individual Firearm License" is a document issued by the Pampanga Police Provincial Office specifically for Pampanga residents.

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APPLICATION FOR RENEWAL OF INDIVIDUAL FIREARM LICENSE
(Requirement & Instruction to applicant: Please see page 2)
ADMIN CONTROL
DATE:
I
-
/
/
Day
Month
Year
Chief, Philippine National Police
(Attn: Chief, FED)
Kind of License applied for
Camp Crame, Quezon City
RL
SP
SCR
SRL
May I respectfully request for the renewal of my firearm license. My personal details, firearms data and compliance to
other requirements in connection with my license to possess firearm are stated below.
WITH CHANGES
NO CHANGES
Owner (Agency)
Last Name:
First Name:
Middle Name:
2” x 2”
Address:
(Colored PHOTO w/
white background)
E-mail Address:
Affix signature
Tel. No.:
On the left side
Date of Birth
/
/
Of the picture
Day
Month
Year
Place of Birth
TIN No.:
-
-
Qualification:
Businessman/Overseas
Private Employee/Individual
Elected Official
PNP/AFP/BJMP/BFP
Specify:
__________________
_____________________
_____________
Rank _________ Branch_______
Professional
Government Employee
Gov’ Official
Ret .PNP/AFP/BJMP/BFP
Specify:
__________________
_____________________
_____________
Rank _________ Branch_______
Others
Retired Gov’t Emp Official
Retired Private
Reservist
Emp./Official
Specify:
__________________
_____________________
_____________
Rank _________ Branch_______
FIREARMS INFORMATION
Source of Firearm (Dealer/Transfer/Amnesty)
Kind
Make
Model
Serial No.
Caliber
RECEIVED BY:
U N D E R T A K I N G
I HEREBY CERTIFY that all statements are true and correct. I further certify that I have no criminal
conviction or pending criminal administrative case before any court of law or administrative body as of this
date. Neither is the firearm described herein involved in any case before any court of law or administrative
________________________________
body as of this date.
Name/Signature
______________________________________________
DATE:
Licensee’s Signature over Printed Name
SUBCRIBER AND SWORN to before me this ________ day of _____________________20____
applicant exhibited to me his/her Residence Certificate No. A ____________________on ________20____
_________________________
NOTARY PUBLIC
RECEIVED BY:
(TO BE FILLED-UP BY AUTHORIZED PROCESSOR)
This will serve as your claim stub. Present this stub in claiming the firearm license card.
NAME OF LICENSEE ___________________________________________________________________
________________________________
Family Name
First Name
Middle Name
Name/Signature
FIREARMS DESCRIPTION _______________________________________________________________
Kind
Make
Model
Serial No.
Caliber
DATE:
APPLICATION FOR RENEWAL OF INDIVIDUAL FIREARM LICENSE
(Requirement & Instruction to applicant: Please see page 2)
ADMIN CONTROL
DATE:
I
-
/
/
Day
Month
Year
Chief, Philippine National Police
(Attn: Chief, FED)
Kind of License applied for
Camp Crame, Quezon City
RL
SP
SCR
SRL
May I respectfully request for the renewal of my firearm license. My personal details, firearms data and compliance to
other requirements in connection with my license to possess firearm are stated below.
WITH CHANGES
NO CHANGES
Owner (Agency)
Last Name:
First Name:
Middle Name:
2” x 2”
Address:
(Colored PHOTO w/
white background)
E-mail Address:
Affix signature
Tel. No.:
On the left side
Date of Birth
/
/
Of the picture
Day
Month
Year
Place of Birth
TIN No.:
-
-
Qualification:
Businessman/Overseas
Private Employee/Individual
Elected Official
PNP/AFP/BJMP/BFP
Specify:
__________________
_____________________
_____________
Rank _________ Branch_______
Professional
Government Employee
Gov’ Official
Ret .PNP/AFP/BJMP/BFP
Specify:
__________________
_____________________
_____________
Rank _________ Branch_______
Others
Retired Gov’t Emp Official
Retired Private
Reservist
Emp./Official
Specify:
__________________
_____________________
_____________
Rank _________ Branch_______
FIREARMS INFORMATION
Source of Firearm (Dealer/Transfer/Amnesty)
Kind
Make
Model
Serial No.
Caliber
RECEIVED BY:
U N D E R T A K I N G
I HEREBY CERTIFY that all statements are true and correct. I further certify that I have no criminal
conviction or pending criminal administrative case before any court of law or administrative body as of this
date. Neither is the firearm described herein involved in any case before any court of law or administrative
________________________________
body as of this date.
Name/Signature
______________________________________________
DATE:
Licensee’s Signature over Printed Name
SUBCRIBER AND SWORN to before me this ________ day of _____________________20____
applicant exhibited to me his/her Residence Certificate No. A ____________________on ________20____
_________________________
NOTARY PUBLIC
RECEIVED BY:
(TO BE FILLED-UP BY AUTHORIZED PROCESSOR)
This will serve as your claim stub. Present this stub in claiming the firearm license card.
NAME OF LICENSEE ___________________________________________________________________
________________________________
Family Name
First Name
Middle Name
Name/Signature
FIREARMS DESCRIPTION _______________________________________________________________
Kind
Make
Model
Serial No.
Caliber
DATE:
INSTRUCTIONS TO APPLICANT
1. This application (2 copies) is good for one (1) firearm only.
2. Fill up all information required or place NA if “not applicable”. Affix your 2” x 2” colored
picture in the space provided in this application form.
3. If there is change in any data (like address, qualification, etc.) indicate the change in the
appropriate spaces. Attach a copy of the document validating the change.
4. WARNING: Before signing this document, read carefully the UNDERTAKING. Aside
from certifying the correctness and truthfulness of your entries, you are also stating you
have no criminal conviction or pending criminal case as of the date of your signature.
Your certification will be subject to verification. Any misdeclaration in this document will
be a basis for the cancellation of your license and confiscation of your firearm without
prejudice to the filing of the appropriate criminal case.
5. Attach the original or authenticated photocopy (duly authenticated by the agency/office
issuing the document) of the following documents to the application form:
?? Old firearm license
?? Special Bank Receipt (SBR) showing payment for firearm license fee and
license card fee
?? Certificate of Attendance to a Gun Safety Seminar
?? Firearms Bond
a. private individual – receipt showing payment for Firearms Bond
b. government employee are exempted – in lieu, current Oath of Office or
Certificate of Duty Status.
6. Application form with lacking entries will not be accepted for processing. Please
ensure that information and documents required are complete before submitting your
application.
7. File your application with the Operations Branch of the Provincial Police Office/City
Police Office or Regional Operations and Plans Division (ROPD) of the Police Regional
Office whose jurisdiction covers your indicated address in the firearm license or directly
at the Firearms and Explosives Division in Camp Crame, Quezon City.
8. Your license card will be released upon the presentation of your claim stub.
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