Application Form for Fresh Arms Licence

Write in English and CAPITAL Use Blue/ Black Ball Pen. One character in Box.
Do not write outside the boxes. SAMPLE How to fill the Form
Tick inside the appropriate Box Only Male. Female
Date of application
Licence No.
PART - A Identity of applicant
Mr. Ms.
1. Name
2. Father's / Husband
Mother's Name :
3. (a) Place of Birth : (b) Nationality
4. Date of Birth in christian era : In Figures (dd mm yy ) (With Documentary proof)
In words : (Capital Letters) ............................................................................................................................................
5. Present Address :................................................................................Residing Since :
Nearest Police Station of Present address :
Telephone : Office : Residence : Mobile :
Fax : E-mail :
6. Permanent Address :
Nearest Police Station of Permanent address :
7. Occupation ( Professional/ Business/Govt. Service/Private Service/Doctor etc.) :
8. Office Address :
PART - B Other's Information of Applicant
9. Whether the Applicant has been :
a) Convicted : Yes No
If yes give the offence (s) the sentence and the date of
sentence at Col. 13
b) Ordered to execute a bond under chapter VIII of Cr.P.C. (2 of 1974)
for keeping the peace or for good behaviour : Yes No
If yes. when, and for which period. give details at Col. 13
c) Prohibited under the Arms Act 1959, for other law
from precessing arms and ammunition : Yes No
If yes. give details at Col. 13
10. a) Whether the applicant applied for a Licence
earlier any where in India : Yes No
If yes when, to whom and with what result. Give details at Col. 13
b) Whether the applicant's Licence was ever :
Suspended Yes No
Cancelled Yes No
Revoked Yes No
If yes when and by whom and on what account, give details at col. 13
c) Whether any other member of the applicant's family is in possession of
an arms licence : Yes No
11. Whether the applicant a) is an exmptee : Yes No
If yes, give description and serial (s) No. of the arms held, at Col. 13
b) has a safe place to keep the arms : Yes No
12. Whether arrested or involved in any criminal case : Yes No
If yes, give details at Col. 13
Attention - Please enclose : (1) Four passport size photograph, One to be pasted on the form and other three to be attested on the reverse by a gazetted officer :
(2) Attested photocopy of the address proof
i) Ration card/ voter's I-card/ passport/ Electricity Bill/ Telephone/ Driving Licence/ Property (House) Tax Return & Pan Card : or
ii) Posting certificate indicating the residential address of the applicant/ recommendation from the commanding / supervisory Gazetted Officer in case of armed force personnel.
Police and para-military forces only : and
3. Proof of date of Birth (Please attach any on mentioned below :
Copy of matriculation Certificate indicating the date of Birth dully attested by a gazetted Officer
Copy of the Birth certificate issued by a Municipality Authority or district office of the Registrar of Births & Deaths dully attested by a gazetted Officer
Affidavit s orn before a Magistrate/Notary starting date and place of Birth by illiterate or semi-
Water Bill /
or
or
w illiterate applicants (specimen language of the affidavit may be taken
from the reception counter of the Licencing Branch, Joint Commissioner of Police, Gurgaon : or
Any other proof (Passport/Driving Licence/PAN Card/ Service I-Card for Government employees issued by the Government Department having Date of Birth /
Army Discharge Certificate etc. please specify)
PAN CARD/ VOTER ID / RATION CARD / PASSPORT NO.
Office of the Joint Commissioner of Police 1st Floor, Mini Secretariat, Gurgaon - 122001
Ph.: 0124-2869336, 2869300, (E-mail : jtcp.ggn@hry.nic.in)
Paste Passport
size photograph
here
R A M S I N G H
13. If any entry in Col. No. 9to 12 is 'YES' then give here details here by writing the particular Column no.:
Col No. Deatails
11 (b) Place where arms/ammunition will be kept -
14. Type of Weapon for which licence is required : a) NPB PB
b) Revolver Pistol Rifle Gun (S.B./D.B.) Other (Pl. specify)
15. Need for the weapon :
16. Any claim for special consideration :
Note : Against co. No. 15 & 16. the applicant should clearly mention. the purpose (s) for which the License is required - such as : use, requisition, possession ,
carrying manufacturer, sale, transfer, repair, convert, proof-test, import transport, self protection, sport, display, destruction of wild animals which do injury to
human beings/cattle, protection of crops and cattle, target practice/ shooting, temporary possession as bonafide traveler visiting India etc.
PART - C Particular in case of already weapon (s)
17. Details of earlier Weapon (s) held a) NPB PB
b) Revolver Pistol Rifle Gun (S.B./D.B.) Other's (Pl. specify)
18. Previous Arms Licence No. If any :
19. Place & route of import or transport :
20. Whether applicant is a bonafide tourist : Yes No If yes,
(i) Country to which the applicant belongs :
(ii) The probable /actual date of arrival by in India
(iii) Whether the applicant is prohibited by the laws of
his/her country from having any arm / ammunition : Yes No
Note : A bonafide tourist is permitted to bring into India arms and ammunition for sports purpose and in reasonable quantities only, subject to the
conditions specified in Sec. 10 of theArmsAct. 1959 &in Rule 32 of theArms Rules, 1962
PART - D For applicant requiring licence for import/ export / transport
If the previous sanction of the concerned authority required under Rule 50 of the Arms Rules, 1962 has been obtained thaen the
copy of document in support thereof should be attached.
Declaration : I hereby declare that the above particulars given in the application are true, complete and correct to the best of my knowledge and belief. I
Understand that in the event of any information being found false or incorrect at any stage. I am liable to be proceeded against and action, taken under the
relevant provisions of ArmsAct, 1959, theArms Rules, 1962, and other central enactments, or the lawfor the time being in fore.
WARNING : Suppression of any factual information or furnishing of any false or wrong information in the application form in violation pr Ri;e 51-A will
render the applicant liable for punishment under section 30 of the Arms Act, 1959 and revocation of license as per Section 17(3) of the Arms Act, 1959.
Place :
Date :
Signature / Thumb impression of the applicant
(Left Hand T.I. if male and Right Hand T.I. if female)
1. Full Name :
(As in the Educational Certificate/Muncipal Record)
2. Aliases, if any :
3. Father's Name :
4. Date of Birth :
5. Temporary Address, Mention Clearly whether tenant : Yes No
6. Permanent Address (Same as in Election Card/Ration Card) :
Residing Since :
7. Duration of Stay : - at permanent address : at temporary
8. Occupation (Profession/Business/Govt./Private Service/Doctor etc.
9. (a) Office Address :
(b) Tel/Mobile No. (c) Income Tax PAN No.
(d) Designation
10. Name of nominee, relationship and his/her address
11. (a) Type of Weapon for which license is required
(b) Need for the weapon
Signature of the Receiving Assistant
(2)
PART-A Particulars of Applicant
ARMS LICENSING BRANCH
(COPY FOR POLICE VERIFICATION)
PART-B To be filled in by the S.H.O
1. Address and Date of Birth verified :
Give details
2. Occupation of the applicant as verified :
Give details
3. Whether any complaint filed against the applicant ?
If yes, give details
4. Involvement in criminal cases ?
If yes, give details
5. Whether arrested in any criminal cases ?
If yes, give details
6. Whether convicted in any criminal case ?
If yes, give details
(3)
7. Whether acquitted in any criminal case, if yes what are the grounds (As per the details of register ?
No. 9 of the P.S.) give detais
8. Whether preventive proceedings initiated to bound down the applicant for keeping good behaviour under Cr. P.C.
& D.P. Act ?
If yes, give detais
9. Does the applicant figure on the BC list of the police station (as per details of register No. 10 of the
Police Station ?
If yes, give details
10. does the name of the applicant figure in Register No. 17 of P.C. ?
If yes, give details
11. Has the applicant been involved in cases with any other agency like CBI, Narcotics Control Bureau, D.R.I.,
Enforcement Directorate etc., which is in the knowledge of the S.H.O., vide D.D. entries of the P.S. for service of
summons, execution of warants etc.
If yes, give details
12. Has the applicant filed any complaint regarding threat to his family ?
If yes, give details
13. Verification of nominee
14. any other remarks :
Witness - I
(Name & Address)
ni, i+ .............................................................. >i,>i,-+.....................................................
f+i .....................................................................................+i a fuau ui i+ui s( s f+
ifri+ afuffri i ic i a fs+i +s nui,nu s( s v+ +u uf +i,+ ziifuf fu s(
Signature
Witness - II
(Name & Address)
ni, i+ .............................................................. >i,>i,-+.....................................................
f+i .....................................................................................+i a fuau ui i+ui s( s f+
ifri+ afuffri i ic i a fs+i +s nui,nu s( s v+ +u uf +i,+ ziifuf fu s(
Signature
Signature of SHO
(Write Full Name, Date and affix stamp)
Remarks of ACP
Signature of ACP
(Write Full Name, Date and affix stamp)
Remarks of DCP
Signature of DCP
(Write Full Name, Date and affix stamp)
AFFIDA AFFIDA AFFIDA AFFIDA AFFIDAVIT VIT VIT VIT VIT
(Specimen of affidavit to be submitted by applicants on non-judicial stamp paper of worth Rs. 10/-
duly attested by a Notary Public. Please fill up all details with due care because your case will be
processed on the basis of the information provided by you vide this affidavit.)
I Son/Daughter/Wife of presently residing
at Since
do solemnly affirm and declare as follows :
1. That my date of birth is (copy of proof-attached) and place of
birth is
2. That my educational qualification is
3. That I am married/unmarried to and that I have
Children namely age about
4. That I am permanent resident of
5. That I am running a private business (copy of registration certificate or sales/services tax deposit slip
or MCF/HUDA Trade license which are attached) whose details is as under :-
(a) Name & Address of business :-
(Proprietorship, Private Limited or Limited Company)
(b) Number of employees
a. Skilled/technical :
(b) Literate :-
(c) Semi Literate (below 10
th
Class):-
(d) IIliterate :-
(e) No. of shops/branches with address :
6. That I am a professional (Doctor, Lawyer, Architect, Engineers, Chartered Accountant etc. (Copy of
registration certificate is attached)
1. Name & Address of firm :
II. Number of employees
a. Skilled/technical
b. Literate
c. Semi literate (below 10th Class)
d. IIliterate
7. That I am working/serving as in the department of
I have attached the NOC issued by my department regarding obtaining an arm license. (In case of
Army personnel attach photocopy of I/Card and serving cum residential certificate issued by the
department or (In case of security guard submit an undertaking from his employer.
Affix self
Attested
photo
That my annual income is Rs. (attach proof of salary slip/Income
Tax Return & daily cash transaction is Rs. (attach documentary proof)
That I am not a short tempered man in family, neighbors, employees, and friends.
8. That I am not a medically fit to handle the weapon (A medical certificate issued by a Doctor (Registered
Medical Practitioner) is attached.
9. That I have proper skill to handle the fire arems (proof attached).
10. That my nominee shall be Shri/Smt. who is my
(relationship) and residing at
11. That I am/was not involved in any criminal case. That I do not have any departmental enquiry,
vigilance proceedings against me or have faced a Court of enquiry, Board of enquiry under the
Army, Navy & Air force Acts.
12. That I have never been extend from my place of stay by any judicial authority and neither am I a
proclaimed offender of any state Govt. or of Haryana Police, and to the best of my knowledge there
is no Red Corner Notice or any other Look out notice pending against me.
13. That I have also no proceeding/cases instituted against me in the CBI, NCB, Enforcement Directorate,
Directorate of Revenue Intelligence, Income Tax and Forest Department pending against me.
14. That I have also not been arrested, deproted or involved in any illegal act in any other country where
I have visited or resided.
15. That I have no arm license issued from any state I india. I have applied for an arm license previously
times.
16. That I will make requisite arrangements from keeping the fire arms in safe custody and to avoid
access of children and other unauthorized persons to the fire arms.
17. That my father has given a consent to transfer his weapon in my name on inheritance basis (FS-58)
(copy attached).
18. That my late father who was holding an arm license No. for
NPB Expired on and I intend to get the transfer
of weapon in my name. The other legal heirs have a given NOCs that they have no objection if the
weapon is transferred in name which is/are attached.
19. That I require an arm license because (Give full details)
The particulars furnished by me above are true & correct to the belief of my knowledge and I have
not concealed or mispresented any facts.
DEPONENT
(Name, Address & Signature)
ATTESTED
Signature and official of notary public
MEDICAL CERTIFICATE OF FITNESS
Certified that I have carefully examined Mr./Mrs. ___________________________________________
S/o D/o _________________________________ R/o ______________________________________
_________________________________________________________________________________
Height ________________________
Weight ________________________
Age ________________________
Eye-Sight ________________________
Blood presure normal (Yes/No) Please specify_____________________________________________
Doformity if any, (Particularly in hands) __________________________________________________
On the basis of examine, I ceritify that he/she is in good mental & physical health and is free
from any deformity which can affect his handling of the weapon.
Any other remarks : _______________________
Signature of applicant _____________________
Dated _________________ Dr. ______________________
Regn. No. & Seal