NSW POLICE FORCE - FIREARMS REGISTRY

ABN 43 408 613 180

Letter of Authority / Permission to Shoot Recreational Hunting / Vermin Control

You may complete this form on-line and print, or print and hand write the details. This form is to be completed by a landowner or occupier to give permission for a licence holder or an applicant for a firearms licence to hunt or shoot vermin on their property. DO NOT use this form to give yourself permission to shoot on your own property. PLEASE NOTE: NSW POLICE MAY VERIFY INFORMATION CONTAINED IN THIS AUTHORITY.

A. LANDOWNER/OCCUPIER DETAILS - Person giving consent

Full Name Date of Birth Male Female NSW Firearms Licence No. NSW Drivers Licence No.

B. LANDOWNER/OCCUPIER CONTACT DETAILS - Person giving consent

Day Time Phone Number Email Address

C. LANDOWNER/OCCUPIER RESIDENTIAL ADDRESS - Person giving consent

Full address including street number, name (or property name), suburb, state and postcode.

D. LANDOWNER/OCCUPIER - If this is the same as the residential address supplied above, mark this box with an 'X'
Name and location of property where permission to shoot is being granted.

Property size in hectares

Type of animals/ vermin to be shot OWNER OCCUPIER

Please indicate if you are the owner or occupier of this property.

E. DETAILS OF PERSON SEEKING PERMISSION

The following person has permission to shoot on the property described above. Full Name Date of Birth Male Female NSW Firearms Licence No. NSW Drivers Licence No.

Please mark with an 'X' the category of firearms for which you have given consent for the applicant to use on your property. CATEGORY A FIREARMS CATEGORY B FIREARMS

F. LANDOWNER/OCCUPIER SIGNATURE
This permission remains in force only while the person giving permission and signing below remains the owner/ occupier of the land concerned. Landowner/Occupier Signature Date

Print Form

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Vers 1.1 March 2012