WARNING: TO MAKE A FALSE OR MISLEADING STATEMENT ON THIS FORM MAY RESULT IN THE DENIAL AND/OR REVOCATION OF YOUR APPLICATION AND/OR LICENCE.
FLA001A: Revised June 2020
To Be Completed in Applicant’s Own Handwriting
Section A
Application Type New Replacement: Defective Stolen Lost Non-Defective
Applicant should attach
one photograph here
(Glue and Staple)
Type of Licence being applied for:
Firearm User’s Licence Business Firearm User’s Licence Restricted
Firearm User’s Licence Firearm User’s (Employee’s) Certificate Firearm Dealer’s Licence
Firearm User’s (Special) Permit Gunsmith Licence
Applicant’s Name – Surname, Christian Name, Middle Name Mr. Mrs. Ms. Other Please state: ________
Other names (Nickname, alias, pet name)
Date of Birth
Gender Male Female
Place and Parish of Birth (Hospital/Home, Clinic)
Nationality
Marital Status
Email Address
Home Telephone No.
Cellular Telephone No.
Business Telephone No. (including Ext.)
Next Of Kin Information
Name – Surname, Christian Name, Middle Name Mr. Mrs. Ms.
Relationship to Applicant
Occupation
Email
Home Telephone No.
Cellular & Business Telephone No.(including extension)
Section B
Tax Registration No. (TRN)
I.D Type and Number (Driver's Licence, Passport, National ID)
Section C
Present Address of Residence
Country
Parish
City/Town
Period of Residence
(e.g. 1987- Present)
Previous Address of Residence
Country
Parish
City/Town
Period of Residence
(e.g. 1943- 1987)
Section D
Name and Address of Present Business/Employer
Date/Time Period
e.g. (2000-Present)
Occupation
Name and Address of Previous Business/Employer
Date/Time Period
e.g.(1999-2000)
Occupation
Section E
Have you ever lived or worked outside of Jamaica? Yes No
If yes, state period(s), name of organisation(s), location(s) and nature of employment in the space below.
If yes, state address of last residence in the space below (if exceeds more than six months)
Section F
State Type and Calibre of Firearm(s) for which the Licence, Certificate or Permit application is being made
Nearest Police Station to Place of Residence
Nearest Police Station to Place of Employment/Business
Section G
To Be Completed by Persons Applying for a Firearm User’s ( Employee’s) Certificate
Name of Employer
Address
Telephone No.
Private Security Regulation
Authority I.D. Card No (Company)
FIREARM LICENSING AUTHORITY
Application for Firearm Licences, Certificates and Permits
WARNING: TO MAKE A FALSE OR MISLEADING STATEMENT ON THIS FORM MAY RESULT IN THE DENIAL AND/OR REVOCATION OF YOUR APPLICATION AND/OR LICENCE.
FLA001A: Revised June 2020
Section H
To be completed by persons Applying for Firearm Special User’s Licence
Name of Firearm Holder in Relation
to whose firearm(s) the
Certificate/Permit is being sought
Address
Telephone No.
Make, Type, Calibre and Serial
No. of Firearm(s)
Section I
Have you ever applied for a Firearm Licence, Certificate or Permit? Yes No
What was the result?
Has any Firearm Licence, Certificate or Permit previously issued to you been revoked seized neither . If yes to revocation
or seizure, state reason:
If yes, complete the section below. N.B. For Private Security Companies, Gun Clubs etc., if additional space is required
then list separately, sign and attach to Application Form.
Type of Licence
Firearm Make, Type, Calibre
Serial No. of
Firearm
Parish of Issue
Date of Issue
Has any previous Firearm issued to you been lost or stolen Neither
Have you ever been detained by police, arrested, charged and/or convicted of a criminal offence locally or abroad? Yes No
If yes, give details
Section J
State your reason(s)for application
Section K (Please read and indicate your agreement to each statement by ticking the boxes and affixing your signature
and the date.)
I attest to the truth of statements made and acknowledge that any statement given if found to be misleading or untrue can
affect the grant of a Firearm Licence, Certificate or Permit.
I declare my willingness to be fingerprinted and consent that such prints may be used to facilitate background security
checks.
I am aware that this application may be discarded should I fail to complete the interview process within 6 months after this
application is submitted.
Applicant’s Signature_______________________________ Date______________________
Section L
For Application & Certification Branch Use Only
Date of Interview:
Method of submission:
Fees paid:
Tax receipt number:
Name of Interviewing Officer:
Signature of Interviewing Officer:
Name of Supervisor:
Signature of Supervisor:
Morpho Results:
Signature_______________________________ Date___________________
Section M
FOR FIREARM LICENSING AUTHORITY BOARD USE ONLY
APPLICANT:
BOARD CHAIRMAN:
APPLICATION NO.:
DATE SUBMITTED TO BOARD:
BOARD MEMBER 2:
DECISION: Approved Denied
CALIBRE:
BOARD MEMBER 3:
COMMENTS:
BOARD MEMBER 4:
BOARD MEMBER 5:
