Personal particulars Name S/o Address Police station District License details Lic No. Issued by Purchase period expires on Valid upto Last renewed by Details of weapons entered on the license: Type Make No. 1 2 3 Fee details (No fee for Entry of weapon/ Cancellation/ Retainer & Death cases) Amnt: Rs. Renewal - Gun Rs.60 +40 if late,Rifle Rs.90+60 if late,Rev Rs.150+100if late Lic. for addl. Weapon/deletion-Gun Rs.40,Rifle Rs.60,Rev/Pistol Rs.100 Change of bore -Gun to rifle Rs.50, Gun to Rev./Pistol Rs.60,Others changes -Nil T R No. Dated Tick mark and Fill only relevant part below : 1. Renewal 2. Lic for addl. weapon 3. Entry of new weapon In time: No / Yes Type: Type: Delay yrs. months. No. Reason for delay: 4.Deletion of weapon: Dealers name: Date of receipt of 45 days notice: Bill No. Date: Days since submission of notice: or seller's name : Fathers name: Weapon to be sold Address: Type of weapon: Police station: Make: Lic. No. No. Valid upto : 4.Deletion of weapon 5. Disposal in case of death Existing bore: Legal hiers: Date of death: Change it to : 1 Date of deposit: 2 Where deposited: 6. Appl. for retainer 3 Release in favour of : Name : 4 S/o : 5 Affidavit by other legal heirs attached: no / yes Relation : 6 7. Extension of jurisdiction all India Specify states . 8.Cancel my license Reason : Business / Land outside Punjab / Travel outside Punjab Supporting document attached : Name Signature Date Portion below for office use only Ren. - Licensee & weapon seen by ADC Not recomm / recom. Not all. Allowed Police has objection /no objection Clerk LPA AC(Gen) ADC/DC ADC/ DC Verification in death case done All necessary documents are in order
