APPLICATION FOR AIRGUN REGISTRATION
Chief, Philippine National Police
No. ______________
(Attn: Chief, FEO)
Camp Crame, Quezon City
Date: _______________
PERSONAL DATA
Complete Name: ________________________________________________________________________
Date of Birth: __________________________________ Place of Birth: _____________________________
Residential Address: _____________________________________________________________________
Citizenship: ________________________ Sex:________________ Marital Status: ___________________
Length of stay in present address: _________________________ Telephone no:_____________________
Provincial Address: ______________________________________________________________________
Provincial/Other Address: _________________________________________________________________
Name of Spouse: _______________________________________________________________________
Next of Kin (if single): _______
_____________________________________________________________
Name & Ages of Children (if any): __________________________________________________________
EMPLOYMENT
Profession: _________________________________ Position: ___________________________________
Name of Company/Office: ________________________________________________________________
Address: __________________________________________ Telephone No: _______________________
Length of Service: __________________________________
CRIMINAL RECORD
Accused/Convicted of any crime? ( ) Yes ( ) No
If yes: When and where filed:_______________________________________________________________
Nature of Offense and Outcome: ______________________________________________________
Name and address of three (3) non-relative character references:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
AIRGUN DATA
Kind
Make
Serial No.
Caliber
SOURCE: ( ) Dealer ______________________ ( ) Transfer ______________________
-----------------------------------------------------------------------------------------------------------------------------------------------I HEREBY CERTIFY that all statements are true and correct. I further certify
that I have no criminal conviction or pending criminal/administrative case before any
court of law or administrative body as of this date. Neither is the airgun described
herein involved in any case before any court of law or administrative body as of this
1X1
date.
Picture
______________________
Applicant’s Signature
SUBSCRIBED AND SWORN to before me this____day of ____________, 20___.
Applicant exhibited to me his/her Community Tax Certificate no. ___________ issued in
__________________________ on _________________, 20___.
Doc No. _______
Page No. ______
Book No. ______
______________________
Series of ______
Notary Public
Right Thumb Mark
-----------------------------------------------------------------------------------------------------------------------------------------------(For FEO Use Only)
Paid thru SBR No. _________ P________
Verified by: _______________
Encoded by: ______________
Recommend Approval:
FERDINAND BAUTISTA DAWAY
Police Senior Superintendent
Chief, EEMD, FEO
F-CSGFEOEEMD-009-2013
ROBERT GATLEC PO
Police Senior Superintendent
OIC, FEO