Vp Form 304A – Fill Out and Use This PDF

VP Form 304A

Send your completed application to:

Licensing & Regulation Division

GPO Box 2807

MELBOURNE 3001

Phone: 1300 651 645

Fax: (03) 9247 6485

Email: licensingregulation@police.vic.gov.au

Web: www.police.vic.gov.au

Victorian Firearm Licence Application Form

Licence Categories: A longarms or A & B Longarms Licence

Part 1 - Type of Application (All applicants must complete this part)

This is an application for	(Cross the relevant box(es) below)
Category	Duration	Category	Duration

Part 2 - Personal Information (All applicants must complete this part)

Current Name

Family Name

First Given Name

Second Given Name

Sex:

Male

Female

Date of

/

/

Third Given Name

Birth:

Previous Name

Have you ever changed your name?

Yes

No

If you cross “yes” you MUST provide a certified copy of your change of name certificate or full birth certificate that includes the schedule of any name changes or marriage certificate.

Residential Address Property name (if applicable)

Flat / Unit Number

Street Number

Lot Number

/

/

Street Name

Street Type (RD, ST, AVE, etc)

*Please Note: If you reside interstate, you will only be eligible for a Victorian licence if your

licence is for a work purpose in Victoria.

Town / Suburb

State

Postcode

Postal Address (only complete this section if you want your licence forwarded to an address different to your residential address)

Box / Bag / Street number

GPO Box

PO Box

Locked Bag

Private Bag

RSD

RMB

Street Name

Street Type (RD, ST, AVE, etc)

Town / Suburb

State

Postcode

REPRINT 11/13

Page 1

Revised 11/13

Part 2 - Personal Information (continued)

Contact details & Driver’s Licence (All applicants must complete, if applicable)

Telephone

(Home)

(Work)

Victorian Driver’s

Licence Number

(Mobile)

E-mail Address (indicate exact case)

Part 3 - Storage Address

Storage Address

The instruction pages describe the storage requirements of Schedule 4 of the Firearms Act 1996.

Storage Address (Please staple additional storage address details to the back of this application if applicable.)

Name of property Owner / Occupier:

Property name (if applicable)

Flat / Unit Number

Street Number

Lot Number

/

/

Street Name

Street Type (RD, ST, AVE, etc)

Town / Suburb

State

Postcode

Page 2

Attach Medical Report here if applicable

Attach longarms safety course certificate here

(All new applicants must attend a longarms safety course)

Part 4 - Medical History (All applicants must complete this part)

Have you in the past 5 years been treated for:

Psychiatric, depression, stress or emotional problems?

Yes

No

Alcohol or drug related problems?

Yes

No

Stroke or head injuries?

Yes

No

Any other medical condition which could preclude you from

Yes

No

obtaining a Firearm Licence and possessing firearms?

Do you have any Physical Disability which may preclude you from

Yes

No

obtaining a firearm licence and possessing firearms?

If you answer “yes” to any of the above, you must obtain a medical report from a doctor who treated you, or is familiar with

your condition, outlining your suitability to hold a firearm licence and possess firearms. (refer to instruction pages)

Part 5 - Previous History (All applicants must complete the first three sections for this part)

Section 1: Offences

Have you ever been found guilty of, or do you have charges pending for, any offence in Australia or Overseas?

Yes

No

If you answered “yes”, which State and Country?

State

Country

Section 2: Licence Refusal / Cancellations

Have you ever been refused a licence or permit for a firearm?

Yes

No

If “yes” indicate the year

Have you ever had a licence or permit for a firearm cancelled?

Yes

No

If “yes” indicate the year

Section 3: Family Violence Intervention Order

Have you ever been subject to a full Intervention Order?

Yes

No

If you answered “no” go to Part 6

If you answered “yes”, have you applied successfully to a

Yes

No

court to be deemed not to be a Prohibited Person?

Section 4: Application to be deemed not to be a Prohibited Person

If you have made an application to be deemed not to be a Prohibited Person in either Section 1 or 3, indicate the court and date of

your application.

Court

Date

/

/

Part 6 - Firearms Safety Course (All new applicants must provide a copy of a safety course certificate)

Page 3

Attach: 100 points of certified identification documents here

(unless you hold a Victorian Firearms, Security or Weapons licence/approval)

Part 7 - Identification Reference

Have you previously held an Interstate Firearms Licence?				Yes		No
If you answered “yes”, please indicate: State		Licence Number
Do you hold a current Victorian Firearm Licence, security licence or CCP Weapon Approval?								Yes		No

If you answered “yes”, please indicate the licence number:

You do not have to provide any further information for Part 7 – Go to Part 8.

If you answer “no” you must provide 100 points of Certified (Signed by the Referee) Identification Documents, being one form of primary identification and one or more forms of secondary identification documents. (See Instruction Pages Part 7) and arrange for the below Declaration by Referee to be completed.

Declaration by Referee and Signature by Applicant

Applicant to sign in the presence of an Acceptable Referee and indicate the type of Identification Documents being provided.

Certified copies (Signed by the Referee) of your Identification documents

must be attached to this application.

Please note: Your referee must not be related to you by birth or marriage, or be your defacto partner and must have known you for at least 12 months.

Page 4

Attach either sport target shooting / hunting / primary production / security – prison guard and/or other official evidence here

Part 8 - Genuine Reasons

The Firearms Act 1996 requires you to have a genuine reason to obtain a Firearm Licence.

Cross the box(es) in the left column for the reason, or reasons, you are applying for, and provide the documents listed in the right hand column for each reason you tick

Genuine Reason (any one or more reasons)

Information and Documents you must provide

1. Sport / Target Shooting

/

/

any type, on approved ranges

(Name of club/organisation)

(Branch)

(Date joined)

Membership

Expiry Date

/

/

Number

AND

Copy of current membership card

OR

Club or organisation’s statement of endorsement.

2. Hunting

1. Evidence of your continual ownership (ie: your most recent Rates Notice), occupancy

or management of land on which you intend to hunt. This must include the property size

and be no more than 12 months old.

Refer to the instruction pages for further

OR

information on evidence for Hunting

2. Victorian Membership of a shooting club or organisation that is approved for the activity

of hunting is sufficient evidence for the reason of hunting. Membership must be current

at the time of application and you must maintain your club membership for the

duration of your firearm licence.

OR

3.Written permission from either the owner or manager of land upon which you intend to hunt. (Letter must contain your name and address, the size and location of the owners property, the owners full name and contact details and must be signed and dated by the owner.) This must be a new letter (no more than 12 months old), not a copy of a letter previously provided.

If providing evidence for either 1 or 3, please complete the following:

Property Size (Hectares)

OR

4.Copy of current Victorian Game Licence.

OR

5.Written evidence of formal hunting contracts.

OR

6.Original copy (issued in the last 12 months) of your Registration of Interest in hunting pest animals on Crown Land from Department of Sustainability and Environment. (DSE)

3. Primary Production

1. Property Location

(either (i) or (ii))

AND

i) Indicate if you are the:

2. Property size (Hectares)

Owner

Or

Lessee / Share Farmer

OR

AND

ii) If NOT an owner or lessee, you must

3. Total hours per week spent on primary production activities

demonstrate that you are regularly engaged in

primary production as a:

AND

Manager

Or

Employee

4. Australian Business Number (ABN)

Refer to the instruction pages for further

AND

Information

5. Type of Primary Production business conducted on property

AND

6. Copy of a recent land rates notice (last 12 months)

OR

7.If a Manager or Employee: Provide written evidence from the Primary Producer of your employment, including his/her documents and information specified at

(1 to 5) above.

Page 5

Part 8 - Genuine Reasons (continued)

The Firearms Act 1996 requires you to have a genuine reason to obtain a Firearm Licence.

Cross the box(es) in the left column for the reason, or reasons, you are applying for, and provide the documents listed in the right hand column for each reason you tick

Genuine Reason (any one or more reasons)

Information and Documents you must provide

4. Security Guard

1. Private Security Licence Number

PLEASE NOTE: You must be the holder of a

Expiry Date

/

/

Private Security licence for the Subactivities of

AND

Cash In Transit or Armed Guard.

2.Provide a letter of endorsement from your employer (Letter must: be on company letterhead, state hours worked, detail duties performed, state that duties require employee to be armed, be signed and dated by Nominee).

AND

3.Copy of your Security Industry Firearms Safety Training Qualification

(No more than 12 months old)

3. Name and address of employer:

			If self employed: Provide copies of contracts including (1) and (3) above.
		5. Prison Guard	1. Provide a letter of endorsement from your employer (Letter must: be on company
			letterhead, state hours worked, detail duties performed, state that duties require employee
			to be armed, be signed and dated by Nominee).
				AND
			2. Copy of your Prison Industry Firearms Safety Training Qualification.
			(No more than 12 months old)
			3. Name and address of employer:

			6.	Firearm Safety Instructor -	Copy of Chief Commissioner’s approved Security Industry / Prison Guard Firearms
					Accreditation Certificate.
			Security Industry / Prison Guard
			7.	Official / Commercial /	Provide sufficient information and documentation to support the genuine official,
					commercial or prescribed purpose relating to your application.
			Prescribed purpose or purpose
			authorized by an Act or regulations