Repub blicofthePhilippines s Depar rtmentoft theInteriorandLoca alGovernm ment NATIO ONALHEAD DQUARTER RS,PHILIPP PINENATIO ONALPOLICE OFFICEOFTHECHIEF,PNP tariat,Perm

Perm mittoCarr ryFirearms sOutsideo ofResidence Secret CampCrame,QuezonCity y

2x2 P Photo Taken Within Months Six (6)M From D Date of Applic cation

MIT ARRY FIR REARMS O OUTSIDE OF RESID DENCE (P PTCFOR) PERM TO CA

New Renew wal

PTC CFORCON NTROLNU UMBER:

DATEFILED:
Persona alData

LastNam me FirstNam me MiddleN Name Qualifier r TaxIden ntificationNumber DateofBirth

FEES:

P1 150.00
P Presidential appointeesand a highranking h government g officials o E Electedofficial (Governorup) ( P PNP/AFP/Rese ervist B BJMP S SeniorCitizens s

Qualific cation

Professio on Nameof fOffice OfficeAd ddress OfficeTe elephoneNo.

HomeAd ddress

P1 1,150.00
E Electedofficials (ViceGovernor ( down) d B BFP/CoastGua ard/ Custom C Police/Airport P Police P

No./Stre eet City/Tow wn/Provin nce Region TelephoneNo.

F FirearmsD Data

P4 4,150.00 Ce ellphoneN No.

Right Thu umbMark

AdminC ControlNo o Kind Make Caliber SerialNu umber

B Businessmen/ Private P individuals/pro i ofessi onals/governm o ment employees e te:Fileyour Not App plicationwiththe PTC CFORSecretariat. PLE EASEDONOTDEAL WITHFIXERS S

AFFIDA AVITOFUND DERTAKING G IH HEREBYCER RTIFYthata allstatemen ntshereina aretrueand dcorrect.I furthercer rtifythatIh havenocrim minalconvic ction orpendingcriminal/ad dministrativ vecasebeforeanycou urtoflawo oradministr rativebody asofthisd date.Neithe eristhefire earm herein invo olved in any case before any court of law or administr y rative body. During the validity o my PTCFO I of OR, described h undertaketoinformth heC,PNPw withinfive(5 5)daysfrom mknowledg geofanycasethatmay ybefiledag gainstme. SU UBSCRIBED AND SW WORN to before me this __ e _____ day of _________ ________ 20 0___ applic cant exhibit to me his/her atta ted h ached proof of f identity.
Signature

RECOMM MEND APP PROVAL / DISAPPR ROVAL

ALEX B. S SINTIN, P PESE Police Sen Superin nior ntendent Chief, PTC CFOR Secre etariat APPRO OVED / DISAPPROV VED
NOTARY PUBLIC

8-2008 ISO 9008

NICANOR A. BART R TOLOME, CSEE Poli Directo General ice or Chief, P PNP

PTCFOR Form No.1 Effe ective September 15, 2011 r

Pulis Ako, Pulis N Po yo

PT TCFOR CONTA ACT NR 723-0401 LOC C-5265

____________________ Date NICANORA.BARTOLOME,CSEE Chief,PhilippineNationalPolice CampCrame,QuezonCity Attention: ALEXB.SINTIN,PESE PoliceSeniorSuperintendent Chief,PTCFORSecretariat DearSir: May I respectfully request for the issuance of a Permit to Carry Firearms Outside of Residence(PTCFOR)formylicensedfirearmdescribedasfollows: Kind: Make: Caliber: SerialNumber: FALicenseAdminControlNo.: Presently,Iamdesignatedasthe____________________________________________ of __________________________________________________ and a firearm holder with no violations committed on any of the rules and regulations on firearm laws as implemented by thePNP. Due to the nature of my position, office or calling, my life has been the subject of severalthreatsbroughtaboutbytheenforcementofmyfunctionsandresponsibility,whichI havetouphold.Attachedaredocumentsrequiredtosupportmyapplication. Iwouldbeverygladtocomplywithotherrequirementsincludingapersonalinterview, asmayberequiredbytheChief,PNPorhisauthorizedrepresentative. IfurtherrecognizetheauthorityvestedintheChief,PNPtorevoke,cancelsuspendor nullifytheissuedPTCFORatanytime. Lastly,IundertaketocomplywithallPNPrules,regulationsandguidelinesknowingfully wellthatthegrantingofthePTCFORisamereprivilege. Respectfullyyours, Applicant ContactNo. MailingAddress
PTCFOR Form No. 2 Effective September 15, 2011

REPUBLIC OF THE PHLIPPINES) ) S.S. Quezon City, Metro Manila )

AFFIDAVIT
I, _____________________________________________ of legal age,

____________ citizen, married / single / widower with permanent address at ____________________________________________________________ after having been duly sworn to in accordance with law do hereby depose and say;

That, I am a registered owner of firearms specified as follows: Kind: Make: Caliber: Serial Number: FA Lic Admin Control No :

That I am a ________________________________________ and due to the nature of my work/job my life has been the subjects of several threats, and

That, I am executing this affidavit to support my request for the approval of my PTCFOR.

That, to attest the truthfulness of the statements, I hereunto affixed my signature this ______ day of _______________ 2011 at Camp Crame Quezon City.

(Affiant)

SUBSCRIBED AND SWORN TO before me this ______ day of ______________ 20___ at 2011 at Camp Crame Quezon City. Affiant exhibited to me his / her Community Tax Certificate No. _____________ issued at _________ 0n _______
Doc No. Book No. Page No. Series of ____________ ____________ ____________ ____________ NOTARY PUBLIC