Application For A Possession And Acquisition Licence Under The Firearms Act (For Individuals Aged 18 And Over) - Canada Page 4

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For Administrative Use
APPLICATION FOR A POSSESSION AND ACQUISITION LICENCE UNDER THE FIREARMS ACT
(for individuals aged 18 and over)
ATTENTION:
Read the Information Sheet for explanations. Use an "X" to indicate your answers (where required). Print clearly in blue or black ink.
I would like to receive all information in:
English
French
A
LICENCE INFORMATION (see Information Sheet)
1. a) I have:
never had a firearms licence
Expired FAC, POL or PAL number
an expired firearms licence
1. b) I request a different licence. I currently have a:
Current FAC number
Firearm Acquisition Certificate (FAC)
Current POL number
Possession Only Licence (POL)
Current PAL number
Possession and Acquisition Licence (PAL)
Current Minor's Licence number
Minor's Licence
2. a) If you are licensed, indicate the class of firearm(s) you now possess. Check all that apply.
Non-restricted
Restricted
Prohibited
I do not possess any firearms.
b) Indicate the class of firearm(s) you wish to acquire and possess in the next five (5) years. Check all that apply.
Non-restricted
Restricted
Prohibited (see Information Sheet)
3. Are you applying under the Aboriginal Peoples of Canada
4. If you are not a resident of Canada, in which province or territory will you be
Adaptations Regulations (Firearms)? (See Information Sheet)
using your firearm(s) the most when in Canada?
No
Yes
If YES, attach form CAFC 1016
B
PERSONAL INFORMATION (Please do not use initials or nicknames - see Information Sheet)
5. a) Last name
b) First name
c) Middle name
6. a) Have you ever changed your name (including by marriage)?
b) Previous last name
c) Previous first name
If YES, indicate previous name in boxes b) and c)
No
Yes
(Attach a separate sheet, if necessary)
7. a) Date of birth (Y / M / D)
b) Place of birth (City / Province / Territory / State)
c) Country
8. Gender
9. Eye colour
10. Height
cm
d) If you were born outside Canada, in what
year were you admitted to Canada?
Male
Female
ft / in
CONTACT INFORMATION
11. a) Daytime telephone number
Extension
b) Evening telephone number
Extension
12. E-mail address (if applicable)
(
)
-
(
)
-
Ce formulaire est disponible en français
Page 1 of 4
RCMP GRC 5592 E-W (2008/05/17) V5
CAFC 921

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