Pre-Licence Qualification Course Enrolment 1234 Personal DetailsFirst Name* Middle Name Last Name* Address Line 1* Address Line 2 Town/Suburb* State* Postcode Email* Mobile Phone Number* Daytime Phone Number (if different to the above) Date of Birth* DD slash MM slash YYYY Drivers Licence or Passport Number* Online course user setup Please enter a desired username for accessing the online course. You will be emailed a link to set your passwordUser name* Personal HistoryHave you in NSW or elsewhere:a) Been refused or prohibited from holding a firearms licence or permit or had a firearms licence or permit suspended, cancelled or revoked?* Yes No b) Been the subject of a Firearms Prohibition Order?* Yes No c) Within the last 10 years been convicted of an offence involving firearms, weapons, prohibited drugs, robbery, violence, terrorism or an offence of a sexual nature?* Yes No d) Within the last 10 years been the subject of a Family Law or Domestic Violence Order or an Apprehended Violence Order (other than an order that was revoked)?* Yes No e) Ever attempted suicide or self harm?* Yes No f) In the past 12 months been treated or referred for treatment for alcoholism, drug dependence or a mental illness within the meaning of the Mental Health Act 2007 or as a mentally disordered person within the meaning of that Act?* Yes No g) Currently subject to a Good Behaviour Bond?* Yes No h) Currently subject to an Interim Apprehended Violence Order?* Yes No i) Currently suffering from any mental illness or other disorder that may prevent you from using a firearm safely?* Yes No Sorry, you are ineligible to participate in shooting activities involving the possession and use of firearms. To have your case adjudicated, download and complete the NSW Firearms Registry P650 form and send the form to: NSW Firearms Registry, Locked Bag 1, MURWILLUMBAH, NSW, 2484 for their adjudication. For more information, please refer to the NSW Police Force website. Pre-Qualification Course* Price: Credit Card* MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Month010203040506070809101112 Year20222023202420252026202720282029203020312032203320342035203620372038203920402041 Expiration Date Security Code Cardholder Name Call Us Now on 02 9486 3077
