Application for a Firearm Certificate

The Parish is registered with the Data Protection Authority and all information is collected and used in compliance with the Data Protection (Jersey) Law 2018 and the Firearms (Jersey) Law 2000.

This application is for (tick box which applies):

¨

the grant of a Firearm Certificate (please complete all parts)

¨

the renewal of a Firearm Certificate (please complete all parts)

¨

the variation of personal details contained on a Firearm Certificate (please complete Parts A, C and E)

¨

the variation of firearm/ammunition details contained on a Firearm Certificate (please complete Parts A, C, D and E)

Please complete this form in BLOCK CAPITALS except when signing.

FOR CFI USE ONLY

Date Stamp

Part A Personal details

1

Title (Mr., Mrs., Ms., Dr., etc.)

2

Surname

3

Forename(s)

4

If you have ever used a surname other than the one given in question 2 please give details – if not write NONE

5

If you have used any forename(s) other than those given in question 3, please give details – if not write NONE

6

Home address

Post Code

Telephone numbers

home

Email address

work

mobile

In what capacity do you occupy your home address? –

Owner/occupier ¨         Tenant ¨         Lodger ¨         Living with parent(s)/relation(s) ¨
Other ¨ (please specify)...........................................................................................................

7

If you have lived at addresses, other than the one given in question 6, during the last 5 years enter the details here

8

Date of birth (DD/MM/YY)

9

Place of birth

10

Nationality

11

Occupation

12

Are you receiving, or have you received in the last 10 years, treatment or advice from a General Practitioner or any other doctor (e.g. a psychiatrist) for any of the following health problems? –

Alcohol misuse                    NO ¨   YES ¨

Misuse of illegal drugs      NO ¨   YES ¨

or prescribed medicines

Depression                            NO ¨   YES ¨

Suicidal thoughts                 NO ¨   YES ¨

or attempted suicide

Drug overdose                     NO ¨   YES ¨

Self-harming                          NO ¨   YES ¨

Manic depression                NO ¨   YES ¨

Hypomania                          NO ¨   YES ¨

Obsessive/

compulsive disorder          NO ¨   YES ¨

Severe anxiety                     NO ¨   YES ¨

Schizophrenia                     NO ¨   YES ¨

Any other psychotic         NO ¨   YES ¨

disorder

Are you liable to any of the following? –

Blackouts                              NO ¨   YES ¨

Fainting                                NO ¨   YES ¨

Sudden or disabling            NO ¨   YES ¨

attacks of giddiness

Epilepsy                               NO ¨   YES ¨

If you have answered YES to any of the above please provide details including dates, treatment received and name of doctor (continue on separate sheet if necessary)

13

Please give details of your current General Practitioner

Name of GP

Address

14

Have you seen a General Practitioner (other than a practitioner in your current practice) in the last 12 months?                                                                                                      NO ¨   YES ¨

If YES, please give details

15

If the application is for the grant of a firearm certificate, give details of any firearm certificates you –

Hold currently

Expiry date

Have previously held

Expiry date

Issuing Connétable (if issued in Jersey)

Issuing Authority (if issued outside Jersey)

16

If the application is for the renewal or variation of a firearm certificate give details of your current certificate

Expiry date

Issuing Connétable

17

Have you, at any time or in any jurisdiction, had an application for the grant, renewal or variation of a firearm certificate or a visitor’s permit refused, or a certificate revoked or partially revoked?                                                                                                                 NO ¨   YES ¨

If YES, please give details

18

Have you ever been convicted of an offence?

(Note: you are NOT permitted to withhold information about a previous conviction)

On renewal or variation details need only be given of convictions since the existing certificate was issued                                                                                           NO ¨   YES ¨

If YES, please give details

19

If YES was this a conviction with a sentence which would prohibit you from possessing firearms and/or ammunition or from holding a firearm certificate? See ‘Notes for applicant no. 2’ below                                                                                                            NO ¨   YES ¨

If YES, please give details

Part B Referees

If your application is for VARIATION only of a firearm certificate this Part may be omitted.

Two referees are required. If you have been resident in Jersey for 2 years, one of your referees must be resident in Jersey. If you have not been resident in Jersey for 2 years, and neither of your referees is resident in Jersey, one of them must have known you for at least 2 years.

If neither of your referees is the secretary of a shooting club, you will be required to demonstrate your prior knowledge of firearms or that you hold a certificate or other authority, issued in another country, to possess firearms and ammunition.

You cannot have as a referee – a member of your family, a registered firearms dealer, a member of the Honorary Police of any Parish, an officer in the States of Jersey Police or your employee or subordinate. Each referee will be subject to a check of police records, their details may be held on computer and they may be required to attend an interview with the Connétable to whom this application is made. Each referee must complete a REFERENCE FORM which may be returned separately to the Connétable.

20

Give the names and addresses of the two people who have agreed to be your referees

Name of 1st referee

Address of 1st referee

Post Code

Contact phone number

Home

Email address

Work:

Mobile:

Name of 2nd referee

Address of 2nd referee

Post Code

Contact phone number

Home

Email address

Work

Mobile

REFEREES’ DECLARATION

I declare that –

a)

to the best of my knowledge and belief the information given in answer to questions 1 to 19 is true;

b)

the photographs enclosed with this application are a current true likeness of the applicant, and that I have endorsed the back of one of the photographs to this effect together with the date on which the likeness was compared; and

c)

the statements made above are true.

Name of 1st Referee

Usual signature of 1st referee

Date

Name of 2nd Referee

Usual signature of 2nd referee

Date

Part C Storage of firearms and ammunition

21

Are the firearms and ammunition listed in Part D to be held at the address given in answer to question 6?                                                                                                          NO ¨   YES ¨

If NO, give details of the address at which the firearms/ammunition are to be held and give the names of the occupier(s) of the property and their firearm certificate number(s)

22

If the answer to question 21 is NO, in what capacity does the occupier of the property at which the firearms/ammunition are to be held occupy the property? –

Owner/occupier ¨         Tenant ¨         Lodger ¨         Living with parent(s)/relation(s) ¨
Other ¨ (please specify)...........................................................................................................

23

What are the storage arrangements for each of the firearm(s) and ammunition?

24

Is the storage locked to prevent, so far as is reasonably practicable, unauthorized persons (see ‘Notes for applicant no. 3’ below) taking or using the firearm(s)/ammunition?

                                                                                                                               NO ¨   YES ¨

If YES give names of all persons who have access to the keys.

If no-one else has access write NONE

Part D Details of firearm(s) and ammunition and reasons to possess

If application is for VARIATION of personal details only and there is no change to the firearm(s)/ammunition held this Part may be omitted.

If there is insufficient room, use a separate sheet of paper (stating the question number to which the information relates), ensure the answer is given to all parts of the question, sign and date all sheet(s).

25

Give details of firearms in your possession at the time of this application

If none write NONE here

Calibre, bore or gauge

Type (including action)

Maker’s name

Identification number if known

Reason for possessing e.g. target shooting, pest control, collector, other (please specify)

Where is it used (give name of Shooting Club, OR for private land the name of owner and address/field no. of the land, etc.)

CFI use

26

Give details of ammunition in your possession at the time of this application

If none write NONE here

Calibre, bore or gauge

Quantity

Reason for possessing

CFI use

27

Give details of each firearm you wish to purchase, acquire or possess, the reasons for requiring each of them (details of shooting disciplines, etc.) and where you intend to use each of them

Calibre, bore or gauge

Type (including action)

Maker’s name

Identification number if known

Reason for possessing e.g. target shooting, pest control, collector, other (please specify)

Where is it used (give name of Shooting Club, OR for private land the name of owner and address/field no. of the land, etc.)

CFI use

28

If you wish to have in your possession more than 5000 rounds of ammunition at any one time state the additional quantity and reason for it

(See ‘notes for applicant no. 8’, below)

Calibre, bore or gauge

Additional Quantity

Reason for possessing

CFI use

29

If you are a member of any shooting club(s) or have applied for membership

please give details (including length of membership) and attach a copy of your club membership

Name of shooting club

Number of years member/date applied for membership

30

Where firearm(s) are to be used on private land that is not an approved Shooting Range, do you have the permission in writing of the land owner to shoot on the land?   NO ¨   YES ¨

If YES enclose a copy/copies of the letter(s) of authorization from the owner(s) which give the address/field no. of (or map showing) the land on which you are permitted to shoot.

Part E Declaration

I/We declare that the statements made on this form are true.

I/We understand that I/we will be subject to a check of police records and that my/our details may be held on computer.

I/We consent to the Connétable approaching the applicant’s doctor to confirm the accuracy of the information provided in response to questions 12 to 14 and I/we understand that we are liable for any costs incurred in this respect.

I/We understand that a firearm certificate is granted subject to the conditions that the applicant will –

(i)     at all times (except in the circumstances mentioned in clause (ii)), store the firearm and ammunition to which the certificate relates in a secure manner so as to prevent, so far as reasonably practicable, access to the firearm or ammunition by an unauthorized person and

(ii)    take reasonable precautions for the safe custody of the firearm and ammunition to which the certificate relates where the firearm or ammunition is in use, or the holder of the certificate has the firearm with the holder for the purpose of cleaning, repairing or testing it, or for some other purpose connected with its use, transfer or sale, or the firearm or ammunition is in transit to or from a place in connection with its use or any such purpose

and confirm that the arrangements I/we have made comply with these conditions.

I/We understand that the Connétable and/or an officer authorized by the Connétable may wish to inspect the storage arrangements for the firearms(s)/ammunition from time to time.

I/We understand that I/we must inform the Connétable if the applicant –

(a)    has any existing certificates in any jurisdiction refused or revoked

(b)    suffers from, or is diagnosed with, any health problem(s) specified in question 12

(c)    is convicted of any offence during the validity of the firearm certificate

(d)    ceases to participate in shooting sports.

Usual signature of applicant

Date

Usual signature of parent or guardian
(If the applicant is under 17 years of age)

Date

This form must be returned to the Connétable of the Parish in which the applicant resides together with:

For grant or renewal of a firearm certificate

1)

Fee of £45 (make cheques payable to “Parish of ….”)

2)

3 identical unmounted photographs showing the current true likeness of the applicant and measuring 45 mm x 35 mm, of which
a)    one shall be signed in ink on the back with the applicant’s usual signature and

b)    two shall contain a signed statement in ink by the referees listed in Part B (a different referee for each photograph) confirming that the photograph is a current true likeness of the applicant, and the date when the likeness was compared.

For variation of a firearm certificate

Fee of £20 payable only if there is an increase in the number of firearms held (make cheques payable to “Parish of ............................….”)

FOR OFFICIAL USE ONLY

NOTES FOR APPLICANT

1.

With certain statutory exemptions, it is an offence for a person to have in their possession, or purchase, or acquire, any firearm or ammunition without holding a firearm certificate. The Firearms (Jersey) Law 2000 applies to all firearms, including shotguns and ammunition, except

(a)    air weapons designed for use under water and air weapons with a muzzle energy of less than one foot-pound;

(b)    flare guns;

(c)    de-activated firearms;

(d)    antique firearms kept as a curiosity or ornament;

(e)    ammunition for an air weapon;

(f)     shotgun cartridges containing 5 or more shot, none of which exceeds .23 inch diameter; and

(g)    blank cartridges not exceeding one inch in diameter, measured immediately in front of the rim or cannelure of the base of the cartridge.

2.

A person sentenced to imprisonment for a term of 3 years or more is prohibited by law from possessing a firearm or ammunition; a person sentenced to imprisonment for a term of 3 months or more but less than 3 years is prohibited for a period of 5 years from the end of the sentence from possessing a firearm/ammunition; this includes detention in a young offenders’ centre (see Article 37 of the Law for full details and circumstances in which such prohibitions may be lifted).

3.

An ‘unauthorized person’ is any person who is not entitled under the provisions of the Firearms (Jersey) Law 2000 to have in their possession the specific firearm/ammunition.

4.

A firearm certificate is granted subject to specified conditions and it is an offence to fail to comply with any condition of a firearm certificate.

5.

A firearm certificate is valid for 5 years from the date of issue or renewal.

6.

The Connétable cannot consider this application until a reference form is received from each Referee named in Part B.

7.

Where information is provided or continued on a separate sheet of paper, the question number to which the information relates must be stated and the information must be signed with the applicant’s usual signature and the date.

8.

The amount of ammunition that a person will ordinarily be permitted to possess at any time is 5,000 rounds. An applicant who wishes possess a greater amount will need to show good reason why he or she should be permitted to do so.

9.

Applicants must ensure they have applied for renewal of their firearm certificates in good time at least 3 months prior to the expiry date so as to allow the necessary checks to be made and the application to be determined. If a firearm certificate is not renewed prior to the expiry date then all firearms/ammunition in the applicant’s possession should be lawfully transferred to a registered firearms dealer or surrendered to the police to avoid being in breach of the law.

Reference Form

The Parish is registered with the Data Protection Authority and all information is collected and used in compliance with the Data Protection (Jersey) Law 2018 and the Firearms (Jersey) Law 2000.

This REFERENCE FORM may be returned to the Connétable separately from the Application Form for a Firearm Certificate. Referees should note that all information contained within the reference form will be treated in the strictest confidence.

Please complete this form in BLOCK CAPITALS except when signing.

Part A Details of applicant

1

Name (title, forenames, surname)

2

Address

3

Date of birth (DD/MM/YY)

4

Place of birth

Part B Details of referee

5

Title (Mr., Mrs., Ms., Dr., etc.)

6

Surname

7

Forename(s)

8

Have you ever used a surname other than the one given in question 6     NO ¨   YES ¨

If YES please give details

9

Have you ever used any forename(s) other than the one given in question 7 NO ¨   YES ¨

If YES please give details

10

Home address

Post Code

Telephone numbers

Home

Email address

Work

Mobile

11

Have you lived at addresses other than the one stated at question 10 during the past 5 years?

                                                                                                                                NO ¨   YES ¨

If YES please give details

12

Date of birth (DD/MM/YY)

13

Place of birth

14

Nationality

15

How long have you known the applicant?

16

In what capacity do you know the applicant?
(e.g. friend/club official)

17

Are you an official of an approved shooting club?                       NO ¨     YES ¨     

If YES give the name of the club

Home Affairs club approval no.

What is your role in the club?

Part C Reference

Note – The referee is required to declare that he/she knows of no reason why the applicant should not be permitted to possess a firearm. The referee should therefore be aware that the law requires a Connétable to be satisfied that the applicant can be permitted to possess a firearm and ammunition without danger to public safety, or to the peace, and that the law prohibits the grant of a firearm certificate to any person whom the Connétable has reason to believe is prohibited from possessing a firearm, to be of intemperate habits, unsound mind or to be for any reason unfit to be entrusted with a firearm. Referees should bear in mind the character, conduct and mental condition of the applicant in so far as they are relevant to these matters. Please give your opinion as to the applicant’s suitability to possess firearm(s)/ammunition or on any other aspect of the application that might be relevant to enable the Connétable to decide whether to grant an application.

18

Personal history of the applicant. Do you have any knowledge of any medical or emotional problems, alcohol, drugs or medication-related abuse, or mental or physical disability suffered by the applicant? Please give details and explain how you came by this information.

19

Domestic circumstances of applicant. Do you have any knowledge of any significant difficulties that the applicant has in any relationship with his or her immediate family or anyone living with the applicant that may give cause for concern given that a firearm/ammunition may be available in the household? Please give details

20

What do you know of the applicant’s experience with firearms?

21

What do you know of the applicant’s attitude towards firearms?

Part D Declaration

I declare that –

(a)

I know of no reason why the applicant should not be permitted to possess a firearm;

(b)

I understand that it is a criminal offence knowingly or recklessly to make a false statement in order to aid or abet the procurement of a firearm certificate;

(c)

I am not a member of the applicant’s family, nor a registered firearms dealer nor the applicant’s employee or subordinate and I am currently not a member of the Honorary Police of any Parish or in the States of Jersey Police;

(d)

I am resident in Jersey and I have known the applicant personally for

(insert length of time);

OR

I am not resident in Jersey but I have known the applicant personally for

(insert length of time;

(e)

I understand that I may be subject to a check of police records and that my details may be held on computer;

(f)

I understand that I may be required to attend a personal interview with the Connétable of the parish to whom this application is made; and

(g)

the statements made by me on this form are true.

Signature

Date

Firearm Certificate

Name and address of holder:

Post Code

Date of birth

Certificate number

Valid from

To

Usual signature of holder

Signature of Connétable

Date

Conditions

This certificate is issued subject to the following conditions specified in Article 9 of the Firearms (Jersey) Law 2000:

1.      On receipt of the Firearm Certificate, the holder of the Firearm Certificate must sign it in ink with the holder’s usual signature.

2.      The holder of a Firearm Certificate must without undue delay, inform the Connétable who issued the Firearm Certificate and the States of Jersey Police Force of any change in the holder’s place of residence.

3.      The holder of a Firearm Certificate must:

i)       at all times (except in the circumstances mentioned in clause (ii)) store the firearm and ammunition to which the Firearm Certificate relates in a secure manner so as to prevent, so far as reasonably practicable, access to the firearm or ammunition by an unauthorized person,

ii)      take reasonable precautions for the safe custody of the firearm and ammunition to which the Firearm Certificate relates where the firearm or ammunition is in use, or the holder of the Firearm Certificate has the firearm with the holder for the purpose of cleaning, repairing or testing it, or for some other purpose connected with its use, transfer or sale, or the firearm or ammunition is in transit to or from a place in connection with its use or any such purpose.

4.      Additional conditions, if any, added by the Connétable

1 Firearms possessed, or authorized to be purchased or acquired

i

Firearms possessed

Calibre, bore or gauge

Type

Maker’s name

Identification number

ii

Firearms authorized to be purchased or acquired

Calibre, bore or gauge

Type

Calibre, bore or gauge

Type

2 Ammunition

Maximum quantity authorized to be possessed at any one time:

Calibre, bore or gauge authorized to be possessed:

Instructions to anybody who sells, lets on hire, gives or lends firearms to the holder of this certificate.

Guidance to holder of certificate

1

You must complete each column of the table of firearms transactions, unless the transaction is only for the loan of a shot gun for a period of not more than 24 hours.

Please ensure that anyone who sells, lets on hire, gives or lends you a firearm or ammunition reads these notes.

2

Unless you are a registered firearms dealer or other person who is entitled to possess a firearm without a certificate, you must send details of the transaction to the Connétable who granted this certificate and the States of Jersey Police Force within 72 hours of the transaction. You must provide a description of the firearm (including its identification number, if any). You must also state whether the firearm was sold, let on hire, given or lent, and give the name and address of the holder of this certificate.

3

You must report any circumstances attending the transaction which appear to require investigation within 48 hours to the Connétable who granted this certificate.

4

If you are selling a firearm which will be sent or posted to another dealer for the buyer to collect in person you must complete this table and notify the police. The dealer who actually hands over the firearm should not complete the table or notify the police (except in circumstances which may require police investigation as above).

Table of Firearms Transactions

Certification

A

Date of sale or transfer

B

Name and address of person selling or transferring firearm

C

State whether sold, let on hire, given or lent

D

Quantity, calibre, bore or gauge, maker’s name and type of firearm, identification number or mark

E

Authority to possess

(e.g. firearm certificate or dealer’s registered number)

I certify that the entries I have made in columns A to E alongside are correct and relate to a transaction with the holder of this certificate, that I have inspected the record of the previous transactions, and that I have satisfied myself that the transaction will not place the holder of the certificate in the possession of firearms in excess of or otherwise than as authorized by this certificate

F Usual signature and date

Permit to remove a firearm and/or ammunition

from or to a ship

Name and address of holder:

This permit authorizes only the removal of the firearms and/or ammunition specified below between the places named below. Possession of a firearm otherwise than in accordance with the terms of this permit may constitute an offence under the Firearms (Jersey) Law 2000.

Post Code                            Date of birth

The holder of this permit is hereby granted permission to remove the firearms and/or ammunition specified below –

Permit number                     Valid from      to

from/to

(state particulars of the ship and also where situated)

Usual signature of holder

Stamp of issuing authority

to/from (state the address to or from which the firearm is to be removed)

Signature of Harbour Master    Date

For the following purpose:

Firearms

Calibre, bore                        Maker’s name                      Type                                    Identification number

or gauge

Ammunition

Calibre, bore or gauge           Calibre, bore or gauge           Calibre, bore or gauge           Calibre, bore or gauge

Quantity                              Quantity                              Quantity                               Quantity

Permit to possess a Firearm and/or Ammunition

This permit is issued under Article 14(8) of the Firearms (Jersey) Law 2000.

The permit holder must report the loss of this permit to the Chief Officer of Police at once.

Name and address of holder:

The holder of this permit is hereby permitted to have in his or her possession (but not to purchase or acquire) the firearms and/or ammunition specified below, on the terms that the holder shall:

Post Code                          Date of birth

Permit number                   Valid from        to

Usual signature of holder

On behalf of the Minister for Justice and Home Affairs

Signature of Chief Officer of Police       Date

Firearms

Calibre, bore                        Maker’s name                      Type                                    Identification number

or gauge

Ammunition

Calibre, bore or gauge           Calibre, bore or gauge           Calibre, bore or gauge           Calibre, bore or gauge

Quantity                              Quantity                              Quantity                               Quantity

Auctioneer’s Firearm Permit

This permit is issued under Article 19(2) of the Firearms (Jersey) Law 2000.

The permit must report the loss of this permit to the Chief Officer of Police at once.

Name and address of holder:

The holder of this permit is hereby permitted to sell by auction, to expose for sale by auction and to have in his or her possession for sale by auction, the firearms and ammunition specified below, on the terms that the holder shall:

Post Code                          Date of birth

Permit number                   Valid from      to

Usual signature of holder

On behalf of the Minister for Justice and Home Affairs

Signature of Chief Officer of Police           Date

Firearms

Calibre, bore                        Maker’s name                      Type                                    Identification number

or gauge

Ammunition

Calibre, bore or gauge           Calibre, bore or gauge           Calibre, bore or gauge           Calibre, bore or gauge

Quantity                              Quantity                              Quantity                               Quantity

Visitor’s permit

This permit is issued under Article 50 of the Firearms (Jersey) Law 2000 by the Chief Officer of Police.

Post Code                          Date of birth

Permit number                   Valid from        expires

Usual signature of holder

Signature of Chief Officer of Police       Date

CONDITIONS

1.    The holder must, on receipt of the permit, sign it in ink with his/her usual signature.

2.    The holder must, at all times when in Jersey, have with him or her any certificate or other authorization authorizing the holder to possess the firearm(s) and any ammunition outside Jersey.

3.    The holder must declare the firearm(s) and any ammunition to Jersey Customs on arrival in Jersey if a Customs Officer is obviously in attendance at the material time.

4.    The holder must not sell, give or otherwise dispose of the firearm(s) or any ammunition within Jersey.

5.    The holder must take reasonable precautions to ensure the safe custody of the firearm(s) and any ammunition when in Jersey.

6.    The holder must report the loss or theft of the firearm(s) or any ammunition, at once, to the Chief Officer of Police.

7.    The holder must export the firearm(s) back to his or her home area on or before the date this permit expires.

8.    The holder must declare the firearm(s) and any ammunition to Jersey Customs on departure from Jersey if a Customs Officer is obviously in attendance at the material time.

9.    The holder must return this permit, within 48 hours of its date of expiry, to: – The Chief Officer, States of Jersey Police, Central Firearms Index, Rouge Bouillon Police Station, St. Helier. JE4 8ZD.

Firearms

Calibre, bore or gauge

AS PER ABOVE CONDITIONS

Maker’s name

Type

Identification number

Ammunition

Calibre, bore or gauge

AS PER ABOVE CONDITIONS

Quantity

Calibre, bore or gauge

Quantity

Application for approval as a shooting club

Please complete this form in BLOCK CAPITALS except when signing.

Part A Details of shooting club

1    Name of club

2    Address of club

3    Names of principal officers of club

4    Location of membership list of club

5    Approval sought as (tick as applicable)

Pistol club

Shotgun club

Rifle club

Miniature rifle club

Part B Officer making application on behalf of shooting club

6      Title

(e.g. Mr. Mrs. Ms., Dr.)

7      Full name

8      Date of birth

9      Position held in club

10    Length of time in position stated in 9

Part C Application and declaration

11    I hereby apply on behalf of the club named in A above

a)   for approval as a shooting club

b)   for renewal of approval as a shooting club

I declare that the above statements are true

Usual signature of applicant                                    Date

Approval as a shooting club

Name and address of club:

This approval is issued under Article 15 of the Firearms (Jersey) Law 2000.

Any change in the personal particulars of the officer of the club to whom the approval is issued must be reported to the Minister for Justice and Home Affairs at once.

Name and address of officer of club to whom approval issued

Type of approval

(Delete the inapplicable)

Valid from

to

On behalf of the Minister for Justice and Home Affairs

Signature of Chief Officer of Police     Date

Firearms dealers: Application for registration or for renewal of registration

Please complete this form in BLOCK CAPITALS except when signing.

Note

Part A must be completed where an application is made by an individual wishing to be registered as a firearms dealer.

Parts B and C must be completed where an application is made on behalf of a company.

Parts D and E must be completed in all cases.

Part A Personal details

1     Title

(e.g. Mr., Mrs., Ms., Dr.)

2  Surname

3     Forename(s)

4     If you have at any time used a name other than those quoted at 2 and 3 above, please give details (including in the case of a married woman, surname before marriage)

5     Date of birth

6  Place of
    birth

7     Nationality

8     Occupation

9     Current home address

Post code

Telephone number

10   Permanent home address (if different from 9)

Post code

Telephone number

11   If you have lived elsewhere than at the addresses quoted at 9 and 10 above during the last 5 years please give details

Post code

Telephone number

12   Have you previously been registered as a firearms dealer in Jersey

                                                                                NO ¨   YES ¨

       If yes, state name under which you were registered

Period of registration

from

to

13   Have you ever had an application for the grant or renewal of a firearm certificate refused or a certificate revoked?

If yes give details

                                                                                 NO ¨   YES ¨

14   Have you ever had an application for registration as a firearms dealer refused, or been removed from a register of dealers?

If yes give details

                                                                                 NO ¨   YES ¨

15   Have you been convicted of any offence?

If yes give details

                                                                                 NO ¨   YES ¨

(Note: This includes convictions in places outside Jersey.)

Part B company details

16   Full name of company

17   Registered number of company

18   Has the company ever traded under a different name?

If yes, state full name of such company

                                                                                 NO ¨   YES ¨

19   Has the company been registered as a firearms dealer elsewhere in the British Isles, under this or any other name?

If yes, state where and certificate of registration number

                                                                                 NO ¨   YES ¨

20   Principal nature of the business with which the company is concerned

21   Names of the officers of the company (including Chairperson, Secretary, Directors, etc.)

22   Do any of the above named officers hold a firearms dealer’s certificate of registration?

If yes, state full name of such officers

                                                                                  NO ¨   YES ¨

23   Is any officer of the company also an officer of another company which holds a firearms dealer’s certificate?

If yes, state details

                                                                                  NO ¨   YES ¨

24   Has the company, trading under this or any other name, ever been removed from a register of firearms dealers?

If yes, state details

                                                                                  NO ¨   YES ¨

25   Has a court ever ordered any of the officers of the company not to be registered as a firearms dealer?

If yes, state details

                                                                                  NO ¨   YES ¨

26   Has a court ever ordered the company not to be registered as a firearms dealer?

If yes, state details

                                                                                 NO ¨   YES ¨

27   Has the company been convicted of any offence?

If yes, state details

                                                                                  NO ¨   YES ¨

Part C Officer making an application on behalf of a company

28    Title

(e.g. Mr., Mrs., Ms., Dr.)

29    Full name

30    Date of birth

31    Position held in company

32    Length of time in position stated in question 31?

Part D Places of business

33    Details of places of business

        Name and

address of

business

Nature of business:

e.g. manufacturing, wholesale, retail, full or part time

Nature of any other business conducted at this address

a)

          Telephone No.

b)

          Telephone No.

c)

          Telephone No.

34    If this is an initial application, please give details of previous experience of handling firearms

35    Proposals for ensuring the safe custody of firearms and/or ammunition if the application is granted

Part E Application and declaration

36    I hereby apply*

I hereby submit this application on behalf of the company named in Part B above*

*delete as appropriate

a)   for registration as a firearms dealer

b)   for a new certificate of registration