Vp Form 1311 - Application For Modification (Variation) To Or Exemption From Handgun Target Shooting Participation
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1
2Send your completed form to:
VP Form 1311
Licensing Services Division
GPO Box 2807
MELBOURNE 3001
Phone: 1300 651 645
E-mail: licensingservices@police.vic.gov.au
Web:
Application for Modification (Variation) to or Exemption from
Handgun Target Shooting Participation
This form is to be completed when a General Category Handgun Licence Holder with the licence reason of
Target Shooting requires a modification (variation) to or exemption from Handgun Target Shooting
Participation in a calendar year.
Part 1 – Handgun Licence Holders Details
Handgun Licence Number
Expiry Date
/
/
Current Name
Family Name
First Given Name
First Given Name
Second Given Name
Second Given Name
Third Given Name
Date of Birth:
/
/
Date of
/
/
Birth:
Third Given Name
Contact details
Telephone
E-mail Address
Part 2 – Type of Application
Modification (Variation) to Participation
Exemption from Participation
Part 3(a) – Reason for Modification (Variation) Application
You were unable to participate in such matches or shoots for reasons outside your control
Effective from
To
REASON: Please provide separately the details explaining why you were unable to participate and include any evidence e.g. documents
that will support your application for modification (variation). NOTE: Medical reason - A medical certificate is required stating the nature of
the condition, expected duration, impact on ability to operate a firearm and the contact details of the signing medical practitioner.
You were unable to complete any such match or shoot you were participating in for reasons outside your control and
the person officiating reasonably believed you had attempted to complete your participation.
Effective from
To
REASON: Please provide separately the details explaining why you were unable to participate and include any evidence e.g. documents
that will support your application for modification (variation). A letter is to be attached from the Sport/Target Club confirming reason.
NOTE: Medical reason - A medical certificate is required stating the nature of the condition, expected duration, impact on ability to operate
a firearm and the contact details of the signing medical practitioner.
12/08
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