Application For A Licence Under The Firearms Act (Pal) (For Individuals Aged 18 And Over) Page 3

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* PART H: PHOTO GUARANTOR (See PHOTO INSTRUCTIONS insert)
21a) Guarantor's last name
21b) Guarantor's first name
22. Telephone number and time when he/she may be contacted
day
(
)
evening
I declare that the photograph on the back of which I have printed and signed my name is an accurate picture of the applicant.
23. Guarantor's signature
24. Date (Y-M-D)
PART I: FIRST REFERENCE (CANNOT BE your spouse and must have known you for at least 3 years)
25a) Reference's last name
25b) Reference's first name
25c) Telephone number and time when he/she may be contacted
day
(
)
evening
25d) Reference's address
25e) Apt. / Unit
25f) City
25g) Province / State
25h) Country
25i) Postal / Zip code
I have known the applicant for THREE YEARS or more. I have read the information supplied by this individual on the above application and find it to be
accurate to the best of my knowledge and belief. I know of no reason why, in the interest of safety, the applicant should not be given a licence to possess
and acquire firearms.
25j) Reference's signature
25k) Date (Y-M-D)
PART J: SECOND REFERENCE (CANNOT BE your spouse and must have known you for at least 3 years)
26c) Telephone number and time when he/she may be contacted
26a) Reference's last name
26b) Reference's first name
day
(
)
evening
26e) Apt. / Unit
26d) Reference's address
26f) City
26g) Province / State
26h) Country
26i) Postal / Zip code
I have known the applicant for THREE YEARS or more. I have read the information supplied by this individual on the above application and find it to be
accurate to the best of my knowledge and belief. I know of no reason why, in the interest of safety, the applicant should not be given a licence to possess
and acquire firearms.
26j) Reference's signature
26k) Date (Y-M-D)
PART K: FEE
Check this box if you are a sustenance hunter. (See Information Sheet)
*
27b) Indicate method of payment. Do not send cash. If you are paying by cheque or money order, make it payable
27a) Fee enclosed
to: Receiver General.
$
Cheque
Certified cheque
Money order
Visa
Master Card
27c) Credit card number
27d) Expiry date
27e) Signature of credit card holder
If paying by credit card,
(if different from applicant)
please complete this section.
PART L: APPLICANT DECLARATION
I declare that the information provided on this form is true and correct to the best of my knowledge and that the photograph enclosed is of me.
28. Applicant's signature
29. Date (Y-M-D)
IT IS AN OFFENCE UNDER SECTION 106 OF THE FIREARMS ACT TO KNOWINGLY MAKE A FALSE OR MISLEADING STATEMENT,
EITHER ORALLY OR IN WRITING, WHEN APPLYING FOR LICENCES, REGISTRATION CERTIFICATES OR AUTHORIZATIONS.
Information in this application is obtained under the authority of the Firearms Act. The information will be used to determine eligibility under the Act and to
administer and enforce the firearms legislation. In addition to the provisions outlined in the Firearms Act, individual rights regarding personal information
are governed by the applicable federal, provincial or territorial legislation governing access to information, freedom of information and/or privacy. Under
Section 55 of the Firearms Act, the firearms officer has the right to ask the applicant for additional information, or to conduct an investigation, by
contacting the applicant's references, photo guarantor, spouse, neighbours and others to determine if a firearms licence should be issued.
CAFC 1039 E (2004/04/15)

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