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 ______________________

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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
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(For FEO Use Only)

Paid thru SBR No. _________ P________

Verified by: _______________
Encoded by: ______________

Recommend Approval:

FERDINAND BAUTISTA DAWAY ROBERT GATLEC PO

Police Senior Superintendent Police Senior Superintendent
Chief, EEMD, FEO OIC, FEO
F-CSGFEOEEMD-009-2013