SAPS 522

SOUTH AFRICAN POLICE SERVICE

CANCELLATION OF AN APPLICATION FOR A LICENCE, PERMIT,

OFFICIAL DATE STAMP A. FOR OFFICIAL USE BY THE POLICE STATION WHERE THE
APPLICATION IS RECEIVED
1
Province
2
Area
3
Police station
4
Component code
5
DATE RECEIVED Firearm applications SAPS 86 NO YEAR
register reference No

B. TYPE OF APPLICATION TO BE CANCELLED (Indicate with an X)

1 4.3
Competency certificates Application for accreditation as an official institution
1.1 5
Application for a competency certificate Permits
1.2 5.1
Application for a further competency certificate Application for a permit to collect ammunition in a private
collection
2 5.2
Licences Application for a permit to collect ammunition in a public
collection
2.1 5.3
Application for a licence to possess a firearm Application for multiple import or export permit
2.2 5.4
Application for a licence to deal in firearms and/or Application for permanent import or export permit
ammunition
2.3 5.5
Application for a licence to manufacture firearms Application for a temporary import or export permit
and/or ammunition
2.4 5.6
Application for a licence to conduct business as a Application for an in-transit permit
gunsmith
3 5.7
Temporary authorizations Application for permit to transport firearms and ammunition
3.1 6
Application for a temporary authorization to possess Application for a duplicate licence, permit, certificate or
a firearm authorization for lost, stolen and defaced licences
3.2 7
Application for a temporary authorization to trade in Application for the renewal of a licence, permit or
firearms and ammunition authorization
3.3 8
Application for a temporary authorization to conduct Application to declare premises a firearm-free zone
business as a gunsmith
3.4 9
Application for a temporary authorization to display Application to manufacture a new firearm or ammunition
firearms and ammunition type
4 10
Accreditations Application for compensation
4.1 11
Application for accreditation as an association Application for authorization to possess more than 2 400
primers
4.2 12
Application for accreditation for business purposes Other (specify)

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 SAPS 522

C. PARTICULARS OF THE APPLICANT

1
NATURAL PERSON’S DETAILS

2
Type of identification (Indicate with an X )

2.1
SA ID Passport
3
Identity number - - -
4
Passport number
5 6
Surname Initials
7
Full names
8
Residential address
9
Postal Code
10
Postal address
11
Postal Code
12 12.1 12.2
Business telephone number Home ( ) Work ( )
12.3 13
Cellphone number Fax ( )
14
E-mail address

15
JURISTIC PERSON’S DETAILS

16
OTHER BODIES

17
Registered company name
18
Trading as name
19
FAR number
20
Postal address
21
Postal Code
22
Business address
23
Postal Code
24 24.1 24.2
Business telephone number Work ( ) Fax ( )
25
E-mail address

26
RESPONSIBLE PERSON’S DETAILS

27
Responsible person (full names and surname)
28
Type of identification (Indicate with an X) SA ID Passport number
29
Identity number of responsible person - - -
30
Passport number of responsible person
31
Cellphone number (if applicable)
32
Physical address
33
Postal Code
34
Business address
35
Postal Code

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 SAPS 522

D. PARTICULARS OF APPLICATION TO BE CANCELLED

1
Type of licence, permit Licence, permit, certificate or Application reference number
certificate or authorization authorization number

2
Reason why cancellation of application is requested

3
Date on which cancellation is requested Date - -

4
Police station that handled the original application
5
Firearm applications register reference number SAPS 86

6
DECLARATION OF REPORTING PERSON

I am aware that it is an offence in terms of the Firearms Control Act, 2000 (Act No 60 of 2000), to make a false statement in this cancellation.

E. SIGNATURE OF REPORTING PERSON (S ign only if applicable)

1 2 Date - -
Name of reporting person in block letters

3
4 Place
Signature of reporting person

F. (This section must be completed only if the reporting person cannot read or write)

1 3
2 Date - -
Fingerprint
designation
4

Name of reporting person in block letters

Place
Right index fingerprint of reporting person

6
PARTICULARS OF POLICE OFFICIAL DEALING WITH THE CANCELLATION

6.1
6.2 -
Name of police official in block letters Persal number of police official

6.3 6.4

Rank of police official in block letters Signature of police official

7
PARTICULARS OF WITNESS

7.1 7.2
-
Name of witness in block letters Persal number of witness

7.3 7.4

Rank of witness in block letters Signature of witness

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 SAPS 522

G. PARTICULARS OF INTERPRETER
(This section must be completed only if the reporting person cannot read or write or does not understand the content of this form.)

1
Name and surname of interpreter
2
Identity/Passport number of interpreter
3
Residential address
4
Code
5
Postal address
6
Code
7 7.1 7.2
Telephone number Home ( ) Work ( )
8 9
Cellphone number Fax ( )
10
E-mail address
11
Interpreted from (language) To

12
Date - -

13 14
Place
Signature of interpreter

15 16
-
Rank of police official in block letters (if applicable) Persal number of police official (if applicable)

H. FOR OFFICIAL USE BY THE DESIGNATED FIREARMS OFFICER/STATION COMMISSIONER

1 2
Date - -
Name of Designated Firearms Officer/Station Commissioner in block letters

3 4
Place
Rank of Designated Firearms Officer/Station Commissioner in block letters

5 6
-
Signature of Designated Firearms Officer/Station Commissioner Persal number of Designated Firearms Officer/Station
Commissioner

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