KELLS RIFLE AND PISTOL CLUB
APPLICATION FORM
ALL SECTIONS MUST BE COMPLETED
Incomplete forms will be returned
Surname...... Forenames......
Home Address......
...... Post Code......
Tel No...... Mobile......
E-Mail Address......
Occupation...... Date of Birth......
Employers Name & Address......
......
Postcode......
Firearms Certificate Number...... Expiry Date......
Are you a member of any other Rifle or Pistol Club? Yes/No
If YES please give details......
......
Please give information on membership of other clubs or associations which you have been, or are currently a member
......
Have you ever been found guilty or convicted of any offences Yes/No
Do you suffer from epilepsy or any sudden attacks of Yes/No
disabling giddiness or fainting
Do you suffer from any other condition or disability which may Yes/No
make possession of a firearm dangerous to you, other club members
or any other person
If you have answer YES to any of the above questions please give details
......
......
......
PTO
I certify that I am not a prohibited person as specified by
Article 63 of the Firearms (Northern Ireland) Order 2004
Article 63 of the Firearms (Northern Ireland) Order 2004
Prohibition of possession, etc, of firearm by certain persons
1. A person convicted of a crime and sentenced to a period of imprisonment or
detention in a young offenders centre of 3 years or more is prohibited for life
from purchasing, acquiring or having a firearm or ammunition in his
possession. Where the sentence is for a period of 3 months or more but less
than 3 years he is prohibited for a period of 8 years. A person sentenced to
detention during the pleasure of the Secretary of State under Article 45(1) of
the Criminal Justice (Children) (Northern Ireland) Order 1998 is also
prohibited for life. The prohibition is effective from the date of conviction
and it applies equally in cases where the sentence is suspended.
2. A person subject to a recognizance to keep the peace or to be of good
behaviour; or a probation order, a condition or requirement of which is that
he shall not possess, use or carry a firearm; or a licence under Article 46 of
the Criminal Justice (Children) (Northern Ireland) Order 1998, must not
purchase, acquire or possess a firearm or ammunition. A person prohibited in
Great Britain under section 21 of the Firearms Act 1968 is also prohibited in
Northern Ireland.
3. Prohibited persons may not possess any firearms or ammunition, not just
those for which the certificate is required. Thus the prohibition extends to all
air guns and air gun pellets.
4. It is an offence to contravene any of the provisions of this Article. It is also an
offence to sell, transfer, repair, test, etc, any firearm or ammunition to or for a
prohibited person.
I declare that all the above information is a true statement and that I have not suppressed or misstated any material fact.
Signed...... Print Name......
Date...... Please enclose one recent colour photographs 45mm x 35mm
Application form must be signed by a proposer, who must be full or associate members of this club.
Proposer...... Membership no......
Note: All Information provided is strictly confidential but can be requested by the PSNI at any time.