APPLICATION FOR COMPENSATION - Saps

SAPS 520(d)
SOUTH AFRICAN POLICE SERVICE
APPLICATION FOR COMPENSATION
Section 137 of the Firearms Control Act, 2000 (Act No 60 of 2000)
OFFICIAL DATE STAMP A. FOR OFFICIAL USE BY THE POLICE STATION
WHERE THE APPLICATION IS CAPTURED
1
Application reference No
DATE RECEIVED
B. FOR OFFICIAL USE BY POLICE STATION WHERE THE APPLICATION IS RECEIVED
1
2
3
4
5
Province
Area
Police station
Component code
General firearm transactions register ref No
C. FOR OFFICIAL USE BY THE CENTRAL FIREARMS REGISTER (CFR)
1
Outstanding/Additional information required
2 3
- Persal number - - Date
4 5
Signature of police official Name in block letters
6
Application for compensation approved
(Indicate with an X)
7
Amount of compensation
to be paid
R -
8 9
- Persal number - - Date
10 11 12
Signature of CFR officer Officer code Name in block letters
13
Application for compensation refused
(Indicate with an X)
14
Reason(s) for refusal
15 16
- Persal number - - Date
17 18 19
Signature of CFR officer Officer code Name in block letters
Page 1 of 5

SAPS 520(d)
D. PARTICULARS OF APPLICANT
1
NATURAL PERSON’S DETAILS
2
Type of identification (Indicate with an X)
2.1
3
4
SA ID Passport Non-SA citizen with permanent residence*
Identity number of natural person - - -
Passport number of natural person
5 6
Surname Initials
7
8
Full name
Residential address
9
Postal Code
10
Postal address
11
Postal Code
12
12.3
14
12.1 12.2
Business telephone number Home ( ) Work ( )
13
Cellphone number Fax ( )
E-mail address
15
JURISTIC PERSON’S DETAILS
16
17
18
19
Registered company name
Trading as name
FAR number
Postal address
20
Postal Code
21
Business address
23 23.1 23.2
Business telephone number Work ( ) Fax ( )
22
Postal Code
24
E-mail address
25
RESPONSIBLE PERSON’S DETAILS
26
27
28
29
30
31
Responsible person (full name and surname)
Type of identification (Indicate with an X) SA ID Passport number
Identity number of responsible person - - -
Passport number of responsible person
Cellphone number
Physical address
33
Postal address
* In case of a non-SA citizen proof of permanent residence must be submitted.
32
Postal Code
34
Postal Code
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35
REPRESENTATIVE’S DETAILS
SAPS 520(d)
36
37
Name and surname
Postal address
39 39.1 39.2
Telephone number Home ( ) Work ( )
38
Postal Code
39.3
41
40
Cellphone number Fax ( )
E-mail address
42
PARTICULARS OF FIREARM LICENCE, PERMIT, CERTIFICATE OR AUTHORIZATION
43
44
Licence, permit, certificate or
authorization type
Licence, permit, certificate or
authorization number
45
DETAILS OF FIREARM
46
47
Type
Calibre
48 Make
49
Model
Firearm component type:
50
51
52
Barrel serial number 50.1
Make
Frame serial number 51.1
Make
Receiver serial number 52.1
Make
53
OTHER PARTICULARS
54
55
56
57
Police station name
SAPS 13 register reference number
Case reference number
Motivation for compensation
58
59
Expected compensation amount R - Amount in words
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SAPS 520(d)
60
BANK PARTICULARS
61
62
63
64
65
66
Account holder name
Account type
Account number
Name of bank
Branch name
Bank branch code
67
DECLARATION BY APPLICANT
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 application
form.
E. SIGNATURE OF APPLICANT (Sign only if applicable)
1
SIGNATURE OF APPLICANT
2
Name of applicant in block letters
3 Date - -
4
Signature of applicant
5 Place
6
SIGNATURE OF REPRESENTATIVE
7 8
Name of representative in block letters
9 10
Signature of representative
Date - -
Place
F. (This section must only be completed if the applicant cannot read or write.)
1
2
Fingerprint
designation
3
Date - -
4
Name of applicant in block letters
Right index fingerprint of applicant
5
Place
6
PARTICULARS OF POLICE OFFICIAL DEALING WITH APPLICATION
6.1
Name of police official in block letters
6.2 -
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
Page 4 of 5

G. PARTICULARS OF INTERPRETER
(This section must be completed only if the applicant cannot read or write or does not understand the contents of this form.)
SAPS 520(d)
1
2
3
Name and surname of interpreter
Identity/Passport number of interpreter
Residential address
4
Postal Code
5
Postal address
6
Postal Code
7
8
10
11
7.1 7.2
Telephone number Home ( ) Work ( )
9
Cellphone number Fax ( )
E-mail address
Interpreted from (language)
to
12
Date - -
13 14
Signature of interpreter
Place
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
RECOMMENDATION REGARDING THE APPLICATION
Recommended
Not recommended
2
Motivation
3 4
Name of Designated Firearms Officer/Station Commissioner in block letters
Date - -
5 6
Rank of Designated Firearms Officer/Station Commissioner in block letters
Place
7 8
Signature of Designated Firearms Officer/Station Commissioner Persal number of Designated Firearms Officer/Station
Commissioner
-
Page 5 of 5