Application For A Possession And Acquisition Licence Under The Firearms Act (For Individuals Aged 18 And Over) - Canada Page 5
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7For Administrative Use
B
PERSONAL INFORMATION (continued)
PROOF OF IDENTITY You must provide the following information about one (1) piece of identification that was issued by a federal, provincial, territorial,
regional or municipal government. The identification must have a number (see Information Sheet). Note that by providing this information you authorize the
Canada Firearms Centre to verify the details with the issuing agency.
13. a) Type of identification
b) Issuing government
c) Identification number
HOME ADDRESS You must provide the physical location where you live (see Information Sheet).
14. a) Street or land location
b) Apt. / Unit
c) City
d) Province / Territory
e) Country
f) Postal code
MAILING ADDRESS Your mailing address is the address where you receive your mail.
Same as home address
15. a) Street / Rural route / PO Box number
b) Apt. / Unit
c) City
d) Province / Territory
e) Country
f) Postal code
C
PERSONAL HISTORY (New Canadian Residents and Non-residents, see Information Sheet)
If you answer YES to any of the questions in this section, you MUST provide details on a separate page. Add your name at the top of each page you
attach. If details are not provided, your application cannot be processed.
A YES answer does not mean your application will be refused but it may lead to further examination.
If you have received a pardon for any offence listed in box 16 a), you are NOT required to disclose the offence.
16. a) During the past five (5) years, have you been charged, convicted or granted a discharge for an offence:
(i) under the Criminal Code or the Youth Criminal Justice Act where violence was used, threatened or attempted;
(ii) involving the misuse, possession or storage of a firearm; or
Yes
No
(iii) involving trafficking or importing drugs or controlled substances?
b) During the past five (5) years, have you been subject to a peace bond, protection order or an order under section 810 of the
Yes
No
Criminal Code?
c) During the past five (5) years, have you or any member of your household been prohibited from possessing any firearm?
Yes
No
d) During the past five (5) years, have you threatened or attempted suicide, or have you suffered from or been diagnosed or
Yes
No
treated by a medical practitioner for: depression; alcohol, drug or substance abuse; behavioural problems; or emotional
problems?
e) During the past five (5) years, do you know if you have been reported to the police or social services for violence, threatened or
Yes
No
attempted violence, or other conflict in your home or elsewhere?
f) During the past two (2) years, have you experienced a divorce, a separation, a breakdown of a significant relationship,
Yes
No
job loss or bankruptcy?
B D
CONJUGAL STATUS (You must answer both questions 17 a) & b) or your licence application will be delayed)
17 a) Do you currently have a spouse, common-law or other conjugal partner?
No
Yes
If yes, you MUST complete section E
b) Within the last two (2) years have you lived in a conjugal relationship
No
Yes
If yes, you MUST complete section F
other than with the person you may have referred to in question 17 a) above?
E
INFORMATION ABOUT CURRENT CONJUGAL PARTNER (see Information Sheet)
CURRENT CONJUGAL PARTNER
Please provide information about your conjugal partner.
18. a) Last name of current spouse, common-law or
b) First name
c) Middle name
d) Date of birth (Y / M / D)
other conjugal partner
If the signature of your current spouse, common-law or other conjugal partner is not provided,
the Chief Firearms Officer has a duty to notify them of your application.
IF YOU HAVE ANY SAFETY CONCERNS ABOUT THIS APPLICATION, PLEASE CALL 1 800 731-4000.
g) Telephone number and time when he/she may be contacted
e) Signature of spouse, common-law or other conjugal partner
f) Date (Y / M / D)
day
Extension
evening
(
)
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Page 2 of 4
RCMP GRC 5592 E-W (2008/05/17) V5
CAFC 921
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