Occupational Disclosure
Primary Producer
WESTERN AUSTRALIA POLICE
STATE CRIME
Licensing Enforcement Division
Licensing Services
303 Sevenoaks St, CANNINGTON WA 6107
MAIL TO: Locked Bag 9, EAST PERTH WA 6892
TELEPHONE: 1300 171 011
FACSIMILE: (08) 9454 1522
EMAIL: [email protected]
This form is only applicable when submitted as a supporting document to an Application.
This document supports an Occupational Use - Primary Production Application.
Applicant Details
Family Name
Date of Birth
All Given Names
Unit / Lot / Level
Street Number
Street Name
Street Type
State
Suburb
Email
Post Code
Home Phone
Work Phone
Licence Number
Expiry Date
Mobile Phone
Property Details
Proprietor of:
Located at:
Property Size:
Property Purpose:
Occupation Details
Occupation:
Length of time in Occupation:
Months/Years
Primary Production Details
Producer of:
Producer of:
Details of loss to Stock and or Property
Stock Loss:
Property Loss:
Vermin:
Monetary Loss:
For this application to be considered, you must attach relevant supporting documents to satisfy the Approving
Officer the damage the vermin is causing, the monetary loss, any alternate control methods that have been taken
to assist with vermin control. Provide documents that confirm Property ownership in the form of Shire Rates
Notices etc. Importantly if this application is for a Category C firearm, you must also explain why a firearm of
Category A or B is not satisfactory.
Applicants
Signature
Occupational Disclosure Primary Producer Version 1.0 11/05/2015
Date
LSF29