Western Australian Consolidated Regulations

FIREARMS REGULATIONS 1974 - SCHEDULE 1

[r. 3]

        [Heading inserted in Gazette 16 Nov 2007 p. 5733.]

1 .         Application for licence

Western Australia Firearms Act 1973			Application for licence
Section 1. Type of application
1.         What type of licence are you applying for?          1. Firearms          2. Collectors 1          3. Corporate 1          4. Dealers          5. Repairers          6. Manufacturers          7. Ammunition collector Note 1:         A person authorised as an agent by a business or company applying for a licence should complete Sections 2 and 3 as if that person was the applicant.
2.         Is this application for an original or additional licence?          Original         As part of your application you must provide your original firearms awareness certificate.          Additional
Section 2. Details of applicant
3.         Your name         Family name			All given names
4.         Residential address         Unit number/Lot number/ Floor level			Street Number
Street name			Street type in full (e.g. Road, Avenue, Court)
Suburb/Town/Locality			State			Postcode
5.         Is the address above your permanent residential address?          Yes          No         You cannot proceed with this application. Please contact Police Licensing Services on 1300 171 011.
6.         Is your postal address the same as your residential address?          Yes         Go to question 8.          No         Complete your postal address below.
7.         Postal address         Unit number/Lot number/Floor level/PO Box/RMB/Locked Bag			Street Number
Street name			Street type in full (e.g. Road, Avenue, Court)
Suburb/Town/Locality			State			Postcode
8.         Is the address above your permanent postal address?          Yes          No         You cannot proceed with this application. Please contact Police Licensing Services on 1300 171 011.
9.         Have you been known by any other name(s)?          Yes         Please provide the other names that you have been known by below.          No         Go to question 10.
Family Name			All given names
Family Name			All given names
Family Name			All given names
10.         Have you lived at any other address during the last 2 years?          Yes         Complete details of each address below.          No         Go to question 11.
Unit number/Lot number/ Floor level			Street Number
Street name			Street type in full (e.g. Road, Avenue, Court)
Suburb/Town/Locality			State			Postcode
Unit number/Lot number/ Floor level			Street Number
Street name			Street type in full (e.g. Road, Avenue, Court)
Suburb/Town/Locality			State				Postcode
11.         Details of birth         Place of birth (Suburb/Town/Locality)
Country of birth
Date of birth NOTE: If you are under 18 years of age you may not apply for a licence.
12.         Have you ever lived outside WA?          Yes         Please provide details of where and when below.          No         Go to question 13.
13.         What is your gender?          Male          Female
14.         Do you have a WA driver’s licence?          Yes         Licence number          No         Go to question 15.
15.         Contact details         Telephone         Home	Work				Mobile
Email address
Section 3. History of applicant
16.         In the last 5 years have you been treated for any medical condition that could effect your fitness to hold a firearms licence or regularly used prescription medication or other drugs?          Yes         Please provide details below.          No         Go to question 17.
17.         Do you have any physical or mental condition that could effect your fitness to hold a firearms licence?          Yes         Please provide details below.          No         Go to question 18.
18.         Do you have a current firearms licence under the WA Firearms Act 1973 ?          Yes         Firearms licence number         Expiry date          No         Go to question 19.
19.         Have you previously held a firearms licence under the WA Firearms Act 1973 ?          Yes         Firearms licence number         Last year held                         (If not known indicate ‘unknown’.)          No         Go to question 20.
20.         Have you ever had a firearms licence or application refused or cancelled or been disqualified from holding a firearms licence?          Yes         Please provide details including where, when and why below.          No         Go to question 21.
21.         Have you ever been convicted of an offence in Australia or overseas?          Yes         Please provide details of all charges, including locations, below.          No         Go to question 22.
22.         Have you ever been found guilty of an offence without a conviction being recorded in Australia or overseas?          Yes         Please provide details of all charges, including locations, below.          No         Go to question 23.
23.         Do you have any outstanding charges against you in Australia or overseas?          Yes         Please provide details of all charges, including locations, below.          No         Go to question 24.
24.         Are you currently or have you ever been bound by a Violence Restraining Order (WA) or equivalent order in Australia or overseas?          Yes         Please provide details, including locations, below.          No         Go to question 25.
25.         Are you applying for a licence as a business or company?          Yes         Please provide the name of the business or company below and an agents nomination form confirming that you have the authority to make the application on behalf of the business or company.          No         Business or company name         You will be contacted by WA Police to provide additional information about your business or company.
Declaration of applicant
I certify that all of the information in this application and in every attachment to it is true and correct. I know it is an offence to provide incorrect or misleading information. Disclaimer and privacy notice — Australia Post is acting as an agent for the Government of Western Australia and collects your information to identify you in accordance with requirements under Australian law. Your details will be forwarded to the Government of Western Australia and may also be disclosed to government agencies such as Centrelink. Subject to certain exceptions you may request access to your personal information. If access is denied, the law says we must tell you why. DO NOT SIGN UNTIL YOU LODGE THIS FORM AT AUSTRALIA POST. Your signature must be witnessed by the Australia Post verifier.
Applicant’s signature Date
Australia Post use only
I confirm that I have sighted original documentation that verifies the applicant’s identity and that the applicant has provided the required documents. Verifier’s name Verifier’s signature Date Work Centre Code Comments
You must complete Sections 5 and 6 if your application includes the licensing of a firearm .
Section 5. Firearms included in application
26.         How many firearms are you applying to licence in this application?         Please attach a firearm serviceability certificate for each firearm to which this application relates.         If you are applying to licence 1 to 5 firearms in this application complete questions 27 to 34 for each firearm.         If you are applying to licence more than 5 firearms in this application complete questions 27 to 34 for 5 of the firearms. WA Police will contact you regarding the other firearms.
27.         What category of firearm are you applying to licence in this application? (The category can be found on the firearm serviceability certificate.)          A or B         You cannot use this application to apply for firearms in any category other than A or B. A separate application should be completed for firearms in categories other than A or B.          C         You cannot use this application to apply for firearms in any category other than C. A separate application should be completed for firearms in categories other than C.          E         You cannot use this application to apply for firearms in any category other than E. A separate application should be completed for firearms in categories other than E.          H         You cannot use this application to apply for firearms in any category other than H. A separate application should be completed for firearms in categories other than H.
28.         What is the firearm serviceability certificate number for the firearm?
29.         What is the most relevant reason for applying for a licence for this firearm?          Club use         You must provide a club support letter confirming that you are a member of an approved shooting club or association.
 Recreational/Hunt/Shoot		You must provide evidence that you have written permission from a landowner to hunt or shoot on his or her land.
 Occupational use — Primary producer		You must provide evidence confirming that you are the owner of land on which the firearm will be used.
 Occupational use — Nominee of primary producer		You must provide evidence confirming that you have permission of the primary producer to use the firearm on land owned by the primary producer.
 Occupational use — Other		You must provide an occupational support document.
 Collector         What is the reason for applying for a licence for this firearm?          Significant commemorative value          Significant historical value          Significant heirloom value          Significant thematic value         Please provide further details about your selected reason in support of your application below.
Is the firearm a handgun?          Yes         Was the handgun manufactured after 1946?                  Yes         Are you a student of arms?                          Yes                                  No                  No         Please provide further details about the firearm below.
 Other use         Please provide details of the other use below.
30.         What is your need for this firearm?         Please provide information relating to your need for this particular firearm below.
31.         Are you applying to be the sole licensee for this firearm?          Yes         Go to question 32.          No         Please select the option below that describes you.                  Primary owner         Please provide the name of the co‑user and licence number of the co‑user (if known).                 Family name                 Given names                 Licence number
 Co‑user         Please provide the name of the primary owner and the licence number of the primary owner (if known).                 Family name                 Given names                 Licence number
 Club armourer         Please provide the name of the club or association for which you are the armourer. You must provide a club support letter that nominates you as the club armourer.                 Name of club or association
32.         How do you intend to obtain this firearm?          Purchase from dealer          Private sale          Co‑use with owner          Transferred ownership          Club owned
33.         Is this firearm currently licensed in WA?          Yes         Please provide the current licence number.          No         Please indicate which of the following best describes this firearm.          Imported from outside Australia          Interstate transfer          Currently unlicensed          Other         Please provide details below.
Section 6. Storage arrangements for this firearm
34.         Is this application for an original licence?          Yes         If your application is successful you will be asked to provide a statutory declaration relating to your storage arrangements for the firearm.          No         Are your storage arrangements sufficient to store the firearms and ammunition for which you already have a licence and this firearm?          Yes         Please complete the details of storage arrangements below.          No         You cannot proceed with this application. Please contact Police Licensing Services on 1300 171 011.
Details of storage arrangements for current firearms My storage arrangements comply with the Firearms Act 1973 and the Firearms Regulations 1974. I have the following —                  A lockable cabinet or container that meets the minimum specification set out in the Firearms Regulations 1974 Schedule 4.                  Other storage facilities described below.
The address where my licensed firearms are stored is —                  my residential address                  as set out below
Unit number/Lot number/Floor level				Street Number
Street name				Street type in full (e.g. Road, Avenue, Court)
Suburb/Town/Locality				State				Postcode

        [Form 1 inserted in Gazette 6 Nov 2009 p. 4425‑37.]

2A .         Application for licence under r.  3BA

Western Australia Firearms Act 1973					Application for licence under Firearms Regulations 1974 r. 3BA 1
Section 1. Type of application and details of previous licence
1.         What type of licence are you applying for? (Tick only one)          1. Firearm licence          2. Firearm collector’s licence          3. Ammunition collector’s licence
2.         Details of the firearm licence, firearm collector’s licence or ammunition collector’s licence you previously held under the Firearms Act 1973 :
Previous licence number					Date of last expiry
If you are applying for a firearm licence or a firearm collector’s         licence go to question 3.         If you are applying for an ammunition collector’s licence go to question 4.
3.         Attachment 1 lists the details of each firearm named and identified in your previous firearm licence or firearm collector’s licence as at the date of its last expiry. 2         Are you applying for a licence for each firearm listed in Attachment 1?          Yes          No         Please specify below (by reference to the Serial No.) each firearm listed in Attachment 1 for which you are not applying for a licence in this application.
Section 2. Details of applicant
4.         Your name         Family name					All given names
5.         Residential address         Unit number/Lot number/ Floor level					Street Number
Street name					Street type in full (e.g. Road, Avenue, Court)
Suburb/Town/Locality					State					Postcode
6.         Is the address above your permanent residential address?          Yes          No
7.         Is your postal address the same as your residential address?          Yes         Go to question 9.          No         Complete your postal address below.
8.         Postal address         Unit number/Lot number/ Floor level/PO Box/RMB/ Locked Bag					Street Number
Street name					Street type in full (e.g. Road, Avenue, Court)
Suburb/Town/Locality					State					Postcode
9.         Is the address above your permanent postal address?          Yes          No
10.         Have you been known by any other name(s)?          Yes         Please provide the other names that you have been known by below.          No         Go to question 11.
Family Name					All given names
Family Name					All given names
Family Name					All given names
11.         Date of birth
12.         Contact details         Telephone         Home		Work							Mobile
Email address
Section 3. History of applicant
13.         In the last 5 years have you been treated for any medical condition that could affect your fitness to hold a licence under the Firearms Act 1973 or regularly used prescription medication or other drugs?
 Yes         Please provide details below.          No         Go to question 14.
14.         Do you have any physical or mental condition that could affect your fitness to hold a licence under the Firearms Act 1973 ?          Yes         Please provide details below.          No         Go to question 15.
You must complete Sections 4 and 5 if your application includes the licensing of a firearm .
Section 4. Firearms included in application
15.         In respect of each firearm listed in Attachment 1 for which you are         applying for a licence, is your reason for wanting to possess the         firearm the same reason you had for possessing the firearm when you         first applied for your previous licence?          Yes         Go to question 17.          No         Go to question 16.
16.         In respect of each firearm listed in Attachment 1 for which you are applying for a licence, what is your current reason for wanting to possess the firearm?
 Club use				You must provide a club support letter confirming that you are a member of an approved shooting club or association.
 Recreational/Hunt/Shoot				You must provide evidence that you have written permission from a landowner to hunt or shoot on his or her land.
 Occupational use — Primary producer				You must provide evidence confirming that you are the owner of land on which the firearm will be used.
 Occupational use — Nominee of primary producer				You must provide evidence confirming that you have permission of the primary producer to use the firearm on land owned by the primary producer.
 Occupational use — Other				You must provide an occupational support document.
 Collector			In respect of each firearm listed in Attachment 1 for which you are applying for a licence, what is your current reason for wanting to possess the firearm?          Significant commemorative value          Significant historical value          Significant heirloom value          Significant thematic value         Please provide further details about your selected reason in support of your application below.
			Is the firearm a handgun?
			 Yes			Was the handgun manufactured after 1946?
						 Yes		Are you a student of arms?
								 Yes  No
			 No			Please provide further details about the firearm below.
 Other use			Please provide details of the other use below.
17.         In respect of each firearm listed in Attachment 1 for which you are         applying for a licence, is your need to possess the firearm the same         need you had in respect of the firearm when you first applied for your         previous licence?          Yes         Go to question 19.          No         Go to question 18.
18.         In respect of each firearm listed in Attachment 1 for which you are         applying for a licence, what is your current need for the firearm?
19.         In respect of each firearm listed in Attachment 1 for which you are         applying for a licence, are you applying to be the sole licensee for the         firearm?          Yes         Go to question 20.          No         In respect of each firearm for which you will not be the sole licensee, please select the option below that will describe you.
 Primary owner					Please provide the name of the co‑user and licence number of the co‑user (if known).
Family name         Given names         Licence number
 Co‑user					Please provide the name of the primary owner and the licence number of the primary owner (if known).
Family name         Given names         Licence number
Section 5. Storage arrangements for firearms included in application
20.         In respect of each firearm listed in Attachment 1 for which you are         applying for a licence, are your storage arrangements for the firearm         the same storage arrangements you had when you first applied for your         previous licence?          Yes         Go to section 6.          No         Go to question 21.
21.         In respect of each firearm listed in Attachment 1 for which you are         applying for a licence, please provide details of your storage         arrangements for the firearm:
The address where my firearms are stored is —                  my residential address                  as set out below
Unit number/Lot number/Floor level							Street Number
Street name							Street type in full (e.g. Road, Avenue, Court)
Suburb/Town/Locality							State				Postcode
Section 6. Statutory declaration by applicant
I, [ name, address and occupation of person making the declaration ] sincerely declare that all of the information provided by me in this application and in every attachment to it is true and correct. This declaration is true and I know that it is an offence to make a declaration knowing that it is false in a material particular.
This declaration is made under the Oaths, Affidavits and Statutory Declarations Act 2005 at [ place ] on [ date ] by — [ Signature of person making the declaration ] in the presence of — [ Signature of authorised witness ] [ Name of authorised witness and qualification as such a witness ]
Attachment 1 — Firearms named and identified in previous firearm licence or firearm collector’s licence (Attach to Form 2A for an application for firearm licence or firearm collector’s licence)
Firearm 1 details
Serial Nos.	Primary Secondary
Manufacturer and model
Action type
Calibre

Notes to Form 2A —

1.         If there is not enough space for any details required, put the details on a separate piece of paper and attach it to this form.

2.         You cannot make an application under r. 3BA in respect of a firearm that is not listed in Attachment 1.

        [Form 2A inserted in Gazette 5 Jul 2011 p. 2828‑33.]

2 .         Firearm awareness certificate

Western Australia Firearms Act 1973	Firearm awareness certificate
Section 1. Details of person to whom certificate is issued
Family name		All given names
Unit number/Lot number/Floor level		Street Number
Street name		Street type in full (e.g. Road, Avenue, Court)
Suburb/Town/Locality		State	Postcode
Section 2. Details of assessor
Family name		All given names
Name of association/club/dealer conducting the test
Address of association/club/dealer Unit number/Lot number/Floor level		Street Number
Street name		Street type in full (e.g. Road, Avenue, Court)
Suburb/Town/Locality		State	Postcode
Licence number of association/club/dealer
Assessor’s position in organisation
Certification
I certify that on ……./……../………. the person named in section 1 above successfully completed in my presence a firearm safety test in accordance with the requirements set out in the Firearms Act 1973 and the Firearms Regulations 1974 . Signature of assessor                                         Date
How many attempts were made to complete the test?

        [Form 2 inserted in Gazette 6 Nov 2009 p. 4438‑9.]

3 .         Firearm serviceability certificate

Western Australia Firearms Act 1973		Firearm serviceability certificate Certificate No.
Firearm details
Manufacturer
Model
Firearm type				Firearm category
Ammunition type				Calibre
Loading method
Primary Serial No.				Secondary Serial No.
Magazine type				Magazine capacity
Is the firearm a handgun				Barrel length (handguns only)
Licensing details of firearm
1.         Current owner of firearm
Family name			All given names
Unit number/Lot number/         Floor level			Street Number
Street name			Street type in full (e.g. Road, Avenue, Court)
Suburb/Town/Locality			State			Postcode
Dealer licence No. (if any)
2.         Is the firearm to be imported into WA?         Yes/No
3.         Is this firearm currently licensed in WA?         Yes/No
If yes, please provide licence number below.
Details of person inspecting firearm
Family name			All given names
Unit number/Lot number/Floor level			Street Number
Street name			Street type in full (e.g. Road, Avenue, Court)
Suburb/Town/Locality			State			Postcode
Licence number of association/club/dealer
Declaration I am —  a licensed firearm dealer  a licensed firearm manufacturer  a licensed firearm repairer  an authorised member of an approved club  a Police Officer
I certify that I have examined the firearm described above and confirm that (please mark each relevant box).  the details of the firearm are correctly described  the firearm is fitted with an effective trigger guard  the firearm is in complete condition without missing parts or components  the firearm has no visible flaws or defects that could effect its operation  the firearm is fitted with stocks/grips that are serviceable
 the firearm has a trigger mechanism that does not operate when a force of one kg is exerted on the mechanism  the firearm is fitted with an appropriate safety mechanism
Signature                         Date

[Form 3 inserted in Gazette 6 Nov 2009 p. 4439‑41.]

[Forms 4 and 5 deleted in Gazette 6 Nov 2009 p. 4425.]

6 .         Application for permit (Act s. 17 or 17A)

FORM 6 Western Australia Firearms Act 1973 Application for permit under Act s. 17 or 17A
Part A  1
Application
I
	(Surname first)
of								Postcode
	(Home address)
								Postcode
	(Postal address)
Telephones				Home		Work			Mobile
Email address
[Complete if application is for a s. 17 permit.]
apply for a permit under the Firearms Act 1973 s. 17 to *possess/*possess and use the firearm and ammunition described in each Part B of this application —
(* delete if inapplicable)
•         for the period beginning on ______ 20___ and ending on ______ 20___ ;
and
•         for these purposes. 6

[Complete if application is for a s. 17A permit.]
in my capacity as  2
of the club, body or organisation described in Part C of this application, apply for an interstate group permit under the Firearms Act 1973 s. 17A for the firearm and ammunition described in each Part B of this application —
•         for the period beginning on ______ 20___ and ending on ______ 20___ ;
and
•         for the group and the purposes  6 described in Part C of this application. A Part B of this application is attached for each firearm and related ammunition for which a permit is wanted.

Applicant’s background
Previous home address  2								Postcode
Date of birth						Place of birth
1.         Have you ever held a licence under the Act?         Yes/No
2.         Have you ever been known by a previous name?  3         Yes/No
If yes, state the name(s)
3.         Have you ever lived outside WA?         Yes/No
If yes, state when
and where
4.         Do you hold a licence under the Act?         Yes/No
If yes, state the No.							and expiry date
5.         Have you ever been refused a licence to possess a firearm anywhere?                 Yes/No
If yes, state when							and where
6.         Has a licence held by you to possess a firearm ever been cancelled anywhere?         Yes/No
7.         Have you ever been disqualified anywhere from holding a licence to possess a firearm?         Yes/No
8.         Have you been convicted anywhere of any offence(s) (including traffic offence(s))?         Yes/No
If yes, state details
9.         Do you have any physical or mental condition that could affect your fitness to hold a firearm licence?         Yes/No
If yes, state details
Applicant’s certificate
I certify that all of the information in this application and in every attachment to it is true and correct. I know it is an offence to provide incorrect or misleading information.
Applicant’s signature									Date
Witness’s details		Surname
		Given names
		Signature							Date

Part B  1 (attach to Part A)
Details of firearm and ammunition  4, 5
Firearm ID No.			Firearm category
Firearm type			Action type
Loading method			Manufacturer and model
Serial Nos.	Primary Secondary		Calibre
Ammunition type			Barrel configuration
Magazine capacity			Barrel length
Ammunition quantity
Licence details
Is this firearm currently licensed in WA?         Yes/No
If yes, state
the licence No.(s)
the name(s) and address(es) of the licence holder(s)
If no, state
where firearm is licensed
the licence No.(s)
the name(s) and address(es) of the licence holder(s)

Part C   1 (attach to Parts A and B)

Details of club, body or organisation for which permit is wanted

Name

Address

Postcode

Telephone

Email address

Members in group

Surname

Other names

Home address

Contest or activity in WA   6

Description

Date(s)

Place(s)

Organised in WA by

Contact person

Name

Address

Postcode

Telephones

Home

Work

Mobile

Notes to Form 6 —

1.         If there is not enough space for any details required, put the details on a separate piece of paper and attach it to this form.

2.         Do not complete this if you have been at your current home address for more than 2 years.

3.         If you have never been known by another name, state ‘Nil’.

4.         If a licence is wanted for 2 or more firearms, fill out a Part B for each firearm and attach it to Part A.

5.         Firearm type: e.g. rifle, shotgun, handgun.

        Action type: e.g. revolving chamber, bolt action.

        Loading method: e.g. single‑shot, repeater.

        Ammunition type: e.g. rim‑fire, air/gas pellet.

        Barrel configuration: e.g. single, double.

        Magazine capacity: e.g. category C1.

6.         See Firearms Act 1973 s. 11A.

        [Form 6 inserted in Gazette 16 Nov 2007 p. 5749‑53.]

7 .         Request to police to take custody of firearm or ammunition (Act s. 33(3))

FORM 7 Western Australia Firearms Act 1973 Request to police to take custody of firearm or ammunition (Act s. 33(3))

Part A   1

Application

I

(Surname first)

of

Postcode

(Home address)

Postcode

(Postal address)

Telephones         Home __________         Work __________         Mobile ____________

Email address

Date of birth

Place of birth

I request the Commissioner of Police to accept for safe custody —                  Each firearm described in each Part B of this application. I attach a Part B for each firearm to which this request relates.                  The ammunition described below. The reasons for the request are —

Details of person to be contacted if applicant is absent

Name

(Surname first)

of

Postcode

(Home address)

Postcode

(Postal address)

Telephones

Home

Work

Mobile

Email address

Applicant’s certificate

I certify that all of the information in this application and in every attachment to it is true and correct. I know it is an offence to provide incorrect or misleading information.

Applicant’s signature

Date

Witness’s details

Surname

Given names

Signature

Date

Part B  1, 2, 3 (attach to Part A)
Details of firearm and ammunition  4, 5
Firearm ID No.			Firearm category
Firearm type			Action type
Loading method			Manufacturer and model
Serial Nos.	Primary Secondary		Calibre
Ammunition type			Barrel configuration
Magazine capacity			Barrel length
Ammunition quantity
Licence details
Licence No.(s)
Name(s) and address(es) of the licence holder(s)

Notes to Form 7 —

1.         If there is not enough space for any details required, put the details on a separate piece of paper and attach it to this form.

2.         If police custody is wanted for 2 or more firearms, fill out a Part B for each firearm and attach it to Part A.

3.         Firearm type: e.g. rifle, shotgun, handgun.

        Action type: e.g. revolving chamber, bolt action.

        Loading method: e.g. single‑shot, repeater.

        Ammunition type: e.g. rim‑fire, air/gas pellet.

        Barrel configuration: e.g. single, double.

        Magazine capacity: e.g. category C1.

        [Form 7 inserted in Gazette 16 Nov 2007 p. 5753‑5.]

8 .         Application for issue or replacement of extract of licence (r. 7A and 8)

FORM 8 Western Australia Firearms Act 1973 Application for issue or replacement of extract of licence
Applicant’s current personal details
Name		Surname
		Given names
Date of birth					Place of birth
Home address
							Postcode
Postal address
							Postcode
Telephones         Home __________         Work __________         Mobile ____________
Email address
Applicant’s current licence details
Licence	Type
	No.
	Expires
Application
I apply for the —  grant of an extract of licence.  renewal of my extract of licence.          issue of a replacement for my extract of licence because it has been         *lost/stolen/destroyed. [* delete if inapplicable]
Applicant’s certificate
I certify that all of the information in this application and in every attachment to it is true and correct. I know it is an offence to provide incorrect or misleading information.
Applicant’s signature								Date
Witness’s details		Surname
		Given names
		Signature						Date

        [Form 8 inserted in Gazette 16 Nov 2007 p. 5755‑6.]

9 .         Firearm licence

Western Australia Firearms Act 1973 s. 16(1)(a)			Firearm licence No. Expires on
This licence is not valid unless a receipt is printed on it or attached to it.
This firearm licence entitles the licensee to possess, carry and lawfully use each firearm named and identified below, and ammunition for that firearm, subject to the Act and any restriction, limitation or condition specified below.
Licensee’s details
Name	Surname
	Given names
Date of birth
Home address	Postcode
Signature
Firearm 1 details and conditions
Firearm ID No.				Firearm category
Firearm type				Action type
Loading method				Manufacturer and model
Serial Nos.	Primary Secondary			Calibre
Ammunition type				Barrel configuration
Magazine capacity				Barrel length
Conditions

        [Form 9 inserted in Gazette 16 Nov 2007 p. 5756‑7.]

10 .         Firearm collector’s licence

Western Australia Firearms Act 1973 s. 16(1)(b)			Firearm collector’s licence No. Expires on
This licence is not valid unless a receipt is printed on it or attached to it.
This firearm collector’s licence entitles the licensee to possess, but not to carry or use, each firearm named and identified below, subject to the Act.
Licensee’s details
Name	Surname
	Given names
Date of birth
Home address	Postcode
Signature
Firearm 1 details and conditions
Firearm ID No.				Firearm category
Firearm type				Action type
Loading method				Manufacturer and model
Serial Nos.	Primary Secondary			Calibre
Ammunition type				Barrel configuration
Magazine capacity				Barrel length

        [Form 10 inserted in Gazette 16 Nov 2007 p. 5757‑8.]

11 .         Corporate licence

Western Australia Firearms Act 1973 s. 16(1)(c)		Corporate licence No. Expires on
This licence is not valid unless a receipt is printed on it or attached to it.
This corporate licence entitles the licensee to possess each firearm named and identified below, and ammunition for that firearm, subject to the Act.
Licensee’s details
Name
ACN (if any)			ABN (if any)
Trading name
Address	Postcode
Firearm 1 details and conditions
Firearm ID No.				Firearm category
Firearm type				Action type
Loading method				Manufacturer and model
Serial Nos.	Primary Secondary			Calibre
Ammunition type				Barrel configuration
Magazine capacity				Barrel length

        [Form 11 inserted in Gazette 16 Nov 2007 p. 5758‑9.]

12 .         Dealer’s licence

Western Australia Firearms Act 1973 s. 16(1)(d)			Dealer’s licence No. Expires on
This licence is not valid unless a receipt is printed on it or attached to it.
This dealer’s licence entitles the licensee to deal in firearms and ammunition on the premises named and identified below, and to do those other things specified in the Act s. 16(1)(d), subject to the Act.
Licensee’s details (if body corporate or partnership)
Name
ACN (if any)				ABN (if any)
Address	Postcode
Licensee’s details (if natural person)
Name	Surname
	Given names
Date of birth
Home address	Postcode
Signature
Licensee’s business details
Trading name
ABN
Business address	Postcode
Premises to which licence applies
Address	Postcode

        [Form 12 inserted in Gazette 16 Nov 2007 p. 5759‑60.]

13 .         Repairer’s licence

Western Australia Firearms Act 1973 s. 16(1)(e)			Repairer’s licence No. Expires on
This licence is not valid unless a receipt is printed on it or attached to it.
This repairer’s licence entitles the licensee to repair firearms and possess ammunition for those firearms on the premises named and identified below, and to do those other things specified in the Act s. 16(1)(e), subject to the Act.
Licensee’s details (if body corporate or partnership)
Name
ACN (if any)				ABN (if any)
Address	Postcode
Licensee’s details (if natural person)
Name	Surname
	Given names
Date of birth
Home address	Postcode
Signature
Licensee’s business details
Trading name
ABN
Business address	Postcode
Premises to which licence applies
Address	Postcode

        [Form 13 inserted in Gazette 16 Nov 2007 p. 5760‑1.]

14 .         Manufacturer’s licence

Western Australia Firearms Act 1973 s. 16(1)(f)			Manufacturer’s licence No. Expires on
This licence is not valid unless a receipt is printed on it or attached to it.
This manufacturer’s licence entitles the licensee to manufacture firearms or ammunition of the kind specified below on the premises named and identified below, and to do those other things specified in the Act s. 16(1)(f), subject to the Act.
Licensee’s details (if body corporate or partnership)
Name
ACN (if any)				ABN (if any)
Address	Postcode
Licensee’s details (if natural person)
Name	Surname
	Given names
Date of birth
Home address	Postcode
Signature
Licensee’s business details
Trading name
ABN
Business address	Postcode
Firearm(s) or ammunition that can be manufactured
Firearm(s)
Ammunition
Premises to which licence applies
Address	Postcode
Conditions

        [Form 14 inserted in Gazette 16 Nov 2007 p. 5761‑2.]

15 .         Shooting gallery licence

Western Australia Firearms Act 1973 s. 16(1)(g)			Shooting gallery licence No. Expires on
This licence is not valid unless a receipt is printed on it or attached to it.
This shooting gallery licence entitles the licensee to conduct a shooting gallery in accordance with the regulations on the premises specified below, subject to the Act.
Licensee’s details (if body corporate or partnership)
Name
ACN (if any)				ABN (if any)
Address	Postcode
Licensee’s details (if natural person)
Name	Surname
	Given names
Date of birth
Home address	Postcode
Signature
Licensee’s business details
Trading name
ABN
Business address	Postcode
Premises to which licence applies
Address	Postcode

        [Form 15 inserted in Gazette 16 Nov 2007 p. 5762‑3.]

16 .         Ammunition collector’s licence

Western Australia Firearms Act 1973 s. 16(1)(h)			Ammunition collector’s licence No. Expires on
This licence is not valid unless a receipt is printed on it or attached to it.
This ammunition collector’s licence entitles the licensee to possess and carry, but not to use, ammunition not exceeding the quantity (if any) specified below and not being of a type prescribed as being ammunition to which an ammunition collector’s licence does not apply, subject to the Act.
Licensee’s details
Name	Surname
	Given names
Date of birth
Home address	Postcode
Signature
Ammunition quantity
Conditions

        [Form 16 inserted in Gazette 16 Nov 2007 p. 5763.]

17 .         Permit (Act s. 17)

Western Australia Firearms Act 1973 s. 17			Act s. 17 permit No.
Part A — Permit and issuing details
This permit entitles the holder to possess temporarily the firearm or ammunition specified below for the purpose and for the period specified below, subject to the Act.
Permit holder’s details
Name	Surname
	Given names
Date of birth
Home address	Postcode
Signature
Permit details
Purpose
Period	From to (both dates inclusive)
Issuing details
Issuing officer	Name Rank                         Reg. No. Signature                         Date
Part B — Firearm and ammunition details
Firearm 1 details
Firearm ID No.				Firearm category
Firearm type				Action type
Loading method				Manufacturer and model
Serial Nos.	Primary Secondary			Calibre
Ammunition type				Barrel configuration
Magazine capacity				Barrel length
Ammunition details
Description
Quantity

        [Form 17 inserted in Gazette 16 Nov 2007 p. 5764‑5.]

18 .         Interstate group permit (Act s. 17A)

Western Australia Firearms Act 1973 s. 17A				Interstate group permit No.
Part A — Permit and issuing details
This interstate group permit entitles the group members specified below to possess or carry the firearms named and identified below and ammunition for those firearms for the occasions(s) and period specified below, as if each member were the holder of a firearm licence.
Permit holder’s details
Details of club or organisation	Name Address                         Postcode
Members in group	Surname		Given names			Address
Permit details
Occasion(s)
Period	From to (both dates inclusive)
Conditions
Issuing details
Issuing officer		Name Rank                         Reg. No. Signature                         Date
Part B — Firearm and ammunition details
Firearm 1 details
Firearm ID No.					Firearm category
Firearm type					Action type
Loading method					Manufacturer and model
Serial Nos.		Primary Secondary			Calibre
Ammunition type					Barrel configuration
Magazine capacity					Barrel length

        [Form 18 inserted in Gazette 16 Nov 2007 p. 5765‑6.]

19 .         Ammunition sales book (r. 17)

Ammunition sales book (r. 17) 1

I certify that all of the details in columns 1 to 7 opposite my signature are true and correct.

Signature

9.

Name

8.

Name and address of persons to whom ammunition supplied

7.

Western Australia Firearms Act 1973

Ammunition supplied

Quantity

6.

Date

5.

Particulars of firearms for which ammunition required

4.

Persons for whom ammunition required

Licence or permit number or reason exempted

3.

Address

2.

Name

1.

Notes to Form 19 —

1.         This book must be completed by a licensed dealer.

        [Form 19 inserted in Gazette 16 Nov 2007 p. 5767.]

20 .         Monthly return by dealer or repairer (stock received) (r. 18)

Western Australia Firearms Act 1973		Monthly return by dealer or repairer (stock received)  1
Dealer or repairer details
Trading name
Licence No.		ABN
Details of firearms and major firearm parts brought into stock in the month of                 20
Transaction No. 1 —
Date
Received from	Name Address Licence/Permit No. If person exempt from licence, state why.
Item received	*Firearm/Major firearm part         [*Delete if inapplicable]
Reason	*Purchased/For repair         [*Delete if inapplicable]
Firearm details —
Firearm ID No.			Firearm category
Firearm type			Action type
Loading method			Manufacturer and model
Serial Nos.	Primary Secondary		Calibre
Ammunition type			Barrel configuration
Magazine capacity			Barrel length
Major firearm part details —
Description
Dealer’s or repairer’s certificate
I certify that all of the information in this return and in every attachment to it is true and correct. I know it is an offence to provide incorrect or misleading information. Signed                                 Date

Notes to Form 20 —

1.         If there is not enough space for any details required, put the details on a separate piece of paper and attach it to this form.

        [Form 20 inserted in Gazette 16 Nov 2007 p. 5768‑9.]

21 .         Monthly return by dealer or repairer (stock outgoing) (r. 18)

Western Australia Firearms Act 1973		Monthly return by dealer or repairer (stock outgoing)  1
Dealer or repairer details
Trading name
Licence No.		ABN
Details of firearms and major firearm parts repaired and delivered, sold or let on hire in the month of                 20
Transaction No. 1 —
Date
Delivered, sold or hired to	Name Address Licence/Permit No. If person exempt from licence, state why.
Item	*Firearm/Major firearm part         [*Delete if inapplicable]
Reason	*Repaired and delivered/Sold/Hired         [*Delete if inapplicable]
Firearm details —
Firearm ID No.			Firearm category
Firearm type			Action type
Loading method			Manufacturer and model
Serial Nos.	Primary Secondary		Calibre
Ammunition type			Barrel configuration
Magazine capacity			Barrel length
Major firearm part details —
Description
Dealer’s or repairer’s certificate
I certify that all of the information in this return and in every attachment to it is true and correct. I know it is an offence to provide incorrect or misleading information. Signed                                 Date

Notes to Form 21 —

1.         If there is not enough space for any details required, put the details on a separate piece of paper and attach it to this form.

        [Form 21 inserted in Gazette 16 Nov 2007 p. 5769‑70.]

22 .         Storage statement (r. 11C)

Western Australia Firearms Act 1973			Storage statement (statutory declaration)
Person making statutory declaration
Name	Surname
	Given names
	Occupation
Date of birth
Home address	Postcode
Statutory declaration
I, the person described above, sincerely declare as follows — To ensure that any firearm or ammunition in my possession is stored in accordance with the Firearms Regulations 1974 r. 11A, I have —
π         A lockable cabinet or container described below that at least meets the specifications described in Schedule 4 of those regulations.
π         A separate lockable metal container described below that is securely affixed to the above cabinet or container, in which to store ammunition.
π         Description of storage arrangements —
Other storage facilities as follows —
The storage facilities are located at —
Unit number/Lot number/ Floor level				Street Number
Street name				Street type in full (e.g. Road, Avenue, Court)
Suburb/Town/Locality				State	Postcode
π         Proof of purchase/fitting of the storage facilities is attached. π         Photographs of the storage facilities including the anchor points of the cabinet or container are attached.
This declaration is true and I know that it is an offence to make a declaration knowing that it is false in a material particular. This declaration is made under the Oaths, Affidavits and Statutory Declarations Act 2005 at on 20 by —
Signature in the presence of this authorised witness — Witness’s signature Name Qualification as authorised witness

        [Form 22 inserted in Gazette 6 Nov 2009 p. 4441‑3.]

23 .         Infringement notice (Act s. 19A)

Western Australia Firearms Act 1973			Infringement notice (expired licence) No.
Licence holder	Surname
	Given names
	Date of birth
	Address
Licence details	Type
	No.
	Expired on
Notice to licence holder	The above licence held by you expired on the above date and was not renewed in the 3 months following that date. As a result it may be alleged you are contravening the Act s. 19.
	If you want the alleged offence dealt with in court, ignore this notice.
	If you do not want to be prosecuted for the alleged offence — (a)         pay the Commissioner of Police $ by way of penalty for the alleged offence; and (b)         get the licence renewed by applying to the police station nearest to where you live and paying the renewal fee, within 28 days after the date you are served with this notice. See over for how to pay. Paying the above amount will not constitute a conviction of an offence under the Act and will not be regarded as an admission of liability for or affect any civil court case.
Officer issuing this notice	Name
	Office held			Reg. No.
	Station/squad

        [Form 23 inserted in Gazette 16 Nov 2007 p. 5771‑2.]

24 .         Infringement notice withdrawal (Act s. 19A)

Western Australia Firearms Act 1973		Withdrawal of infringement notice No.
Licence holder	Surname
	Given names
	Date of birth
	Address
Licence details	Type
	No.
Infringement notice	No.
	Date issued
Notice to licence holder	The above infringement notice, which was issued in relation to the expiry of the above licence, has been withdrawn.
Date of this notice
Officer issuing this notice	Name
	Office held		Reg. No.
	Station/squad

        [Form 24 inserted in Gazette 16 Nov 2007 p. 5772.]

25 .         Application for search warrant (Act s. 26(1))

Western Australia Firearms Act 19 73 s. 26(1)		Application for search warrant
Applicant’s details	Name
	Office held		Reg. No.
	Station/squad
Suspected offence(s)	Date Place Act name and section Description
Thing(s) to be searched for	Description of any firearm, ammunition, silencer etc. involved.
Place to be searched	Description Address
Grounds	I suspect the above thing(s) — π         were involved in the above offence; π         will afford evidence of the commission of the above offence; π         will be used to commit the above offence. I suspect the above thing(s) are at the above place. My grounds for suspecting these matters are — 1.
Application	I apply for a search warrant to be issued under the Act s. 26(1) to search the above place for the above things. I [ insert an oath or affirmation according to the Oaths, Affidavits and Statutory Declarations Act 2005 ] that the information in this application is true to the best of my knowledge and belief. Signed                         Date
Witness’s details	Name Office         Justice of the Peace Signature                         Date

        [Form 25 inserted in Gazette 16 Nov 2007 p. 5773.]

26 .         Application for search warrant (Act s. 26(2))

Western Australia Firearms Act 1973 s. 26(2)			Application for search warrant
Applicant’s details	Name
	Office held			Reg. No.
	Station/squad
Thing(s) to be searched for	Description of any firearm or ammunition
Person in possession of things	Surname Given names
Place to be searched	Description Address
Grounds	I suspect the above thing(s) are in the possession of the above person and — π         possession of the thing(s) by that person may result in harm being suffered by any person; π         that person is not a fit and proper person to be in possession of the thing(s). My grounds for suspecting these matters are — 1.
Application	I apply for a search warrant to be issued under the Act s. 26(2) to search the above place for the above things. I [ insert an oath or affirmation according to the Oaths, Affidavits and Statutory Declarations Act 2005 ] that the information in this application is true to the best of my knowledge and belief. Signed                         Date
Witness’s details	Name Office         Justice of the Peace Signature                         Date

        [Form 26 inserted in Gazette 16 Nov 2007 p. 5774.]

27 .         Search warrant (Act s. 26(1))

Western Australia Firearms Act 1973 s. 26(1)			Search warrant
To	All police officers
Application	The applicant has applied under the Firearms Act 1973 s. 26(1) to me, a Justice of the Peace, for a search warrant.
Applicant’s details	Name
	Office held				Reg. No.
	Station/squad
Suspected offence(s)	Date Place Act name and section Description
Warrant	This warrant authorises you to enter and search the place described below for the thing(s) described below, and to seize any such thing found and take it before a Justice of the Peace to be dealt with according to law.
Thing(s) to be searched for
Place to be searched	Description Address
Issuing details	Name of JP
	Date				Time
JP’s signature	Issued by me on the above date and at the above time. Justice of the Peace
Execution details	Start	Date         Time		End	Date         Time
	Occupier present? Yes/No Search audiovisually recorded? Yes/No Thing(s) seized? Yes/No
Officer in charge of execution	Name
	Office held				Reg. No.
	Station/squad

        [Form 27 inserted in Gazette 16 Nov 2007 p. 5775.]

28 .         Search warrant (Act s. 26(2))

Western Australia Firearms Act 1973 s. 26(2)			Search warrant
To	All police officers
Application	The applicant has applied under the Firearms Act 1973 s. 26(2) to me, a Justice of the Peace, for a search warrant.
Applicant’s details	Name
	Office held				Reg. No.
	Station/squad
Suspected offence(s)	Date Place Act name and section Description
Warrant	This warrant authorises you to enter and search the place described below for the thing(s) described below for the purposes of exercising the powers in section 24(2) of the Act.
Thing(s) to be searched for	Description of any firearm, ammunition, silencer etc. involved
Place to be searched	Description Address
Issuing details	Name of JP
	Date				Time
JP’s signature	Issued by me on the above date and at the above time. Justice of the Peace
Execution details	Start	Date         Time		End	Date         Time
	Occupier present? Yes/No Search audiovisually recorded? Yes/No Thing(s) seized? Yes/No
Officer in charge of execution	Name
	Office held				Reg. No.
	Station/squad

        [Form 28 inserted in Gazette 16 Nov 2007 p. 5776‑7.]