Magistrate Bhadrak

1. Name: 2. Father/ Husband's name: 3. Place of birth/ nativity: 4. Date of Birth in Christian era (Both in words and figures :-) 5. Present address At:P.O:P.S:Dist:Nearest police station 6. Permanent address At:P.O:P.S:Dist:Nearest police station

7) Occupation, and designation of office, held if any (Together with address)

Signature/Thumb Impression (Note:- Nearest police station means the police station under whose jurisdiction the place given in the address comes)

Whether the applicant:a. if so when and for what period. i. if so description of the Arms held.PART. when to whom and with that result. Name of country to which belongs: Whether he is prohibited by the laws of his country from having in his possession any arm ammunition: iii.B OTHER PARTICULARS OF APPLICANT 9. 10. Has a safe place to keep the arms. The probable date of his arrival in India: Note: A bonafide tourist is permitted to bring into India subject to the conditions specified in section 10 and in rule 32 arms and ammunition in reasonable quantities for his use for purpose only of sports and for no other purpose. c. (c) Whether any other member of the applicant's family is in possession of arms license. Convicted ( if so . b.the offence's ) the sentence and date of sentence b. . c. (b) Whether the applicant's license was over suspended or cancelled revoked if so when and by whom and what account. ii. if so Particulars thereof 11.1973 (2 of 1974) for keeping the peace or for good behavior. Is a licensee or exemptee. if so. Prohibited under the arms act 1959 or any other law from having the arms / ammunition. (a) Whether the applicants applied for a license before it so. Ordered to execute a bond under Chapter VIII of code of criminal procedure. Is a bonafide tourist. Whether the applicant has been a.

convert.Need for license: 13. temporary possessing bonafide traveler visiting India etc. PART.Other particulars required as in the relevant license form 17.D FOR APPLICANT REQURING LICINSE FOR IMPORT/ EXPORT/ TRANSPORT/REEXPORT & REIMPORT 18. manufacture. export. transport.Strike off the entries not relevant Warning:.(a) Whether the provisions sanctioned of the concerned authority required and under rule 50. carrying. sale. possession. distribution of wild animals which do injured to human beings / cattle.Suppression of any factual information or furnishing of any false or wrong information in the application form is violation of rule 51-4 will render the applicant liable for punishment under section 30 of the arms Act. repair. import. display.Description of Arms / ammunition: 15. if so (b) The evidence in support thereof Declaration: I hereby declare that the above particulars given in the application are true.(a) Area within which applicant wished to carry arms (b) Place where arms/ ammunition will be kept/ manufacture etc. the arms rules 1962 and other general enactment the law for the time being in force. 16. re-import. I undertake and understand that in the event of any information to be proceeded against and action taken under the relevant provisions of the arms act. Place: Date Place Signature/ Thumb impression of the applicant.Any claims for special consideration Note: Against Column 12 the applicant should clearly mention the purpose9s) for which the license is required such as use accusation. self-protection. 1950. protection of crops and cattle. transfer. target practice/shooting. profitest.PART-C PARTICULAR OF LICENSE 12. complete and correct to the best of my knowledge and belief.the forms in which the license is required: 14. if any has been obtained. Note:. sport. 1959 .

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