This form is NOT to be used for temporary surrender made in accordance with the Bail Act 1985
INSTRUCTIONS Surrendering Person Complete Part A and Part B of this form. Receiving SAPOL Officer Complete Part C of this form. Verify the firearm details from the item and FCS. Lodge the items with PPMS and records the PPMS number. Ensure the item holds the correct release authority e.g. destruction. Scan and email to Firearms Branch. Email: SAPOL.FirearmsBranch@police.sa.gov.au Attach original to the firearm for completion by Armoury OR to the gel blaster firearm for local destruction policy. Armoury Complete Part D and file locally.
Lodging Instructions to PPMS
All firearms should be considered loaded until proven safe Always point the firearm in a safe directions Keep your finger OFF the trigger Do not accept batteries and accessories for gel blasters Refer to the ‘Safe Handling of Firearms Manual’ for safe receipt and storage practices.
PART A: TO BE COMPLETED BY THE SURRENDERING PERSON
I wish to remain anonymous in accordance with the General Amnesty, s64 Firearms Act 2015.	OR
I,
(Full Name)
of
(Full Address)
Contact Telephone:	Home:	( )	Work:	( )	Mobile:
Firearms Licence Number: (if applicable)	Not Licenced
hereby surrender this firearm as required by the Firearms Act 2015. hereby surrender this firearm as a General Amnesty item in accordance with s64 Firearms Act 2015. hereby surrender unconditionally to the South Australia Police, this firearm which is MY PROPERTY, and I will not make any claim whatsoever in relation to this firearm.
Make of Firearm:
Type:
Serial Number:	Calibre:
Signature:	Date:	/ /
PART B: GENERAL AMNESTY DETAILS (Optional for person surrendering items under Amnesty)
What was the reason for the Amnesty surrender?
Firearm is no longer wanted	A sense of responsibility
To avoid being charged with an offence	Other reason
What is the reason for not surrendering earlier?
Firearm is new to surrender	Did not have the time or opportunity
Was not aware of the amnesty	Other reason
PART B: GENERAL AMNESTY DETAILS - Continued (Optional for person surrendering items under Amnesty)
How was the firearm obtained?
In possession prior to the 1996 buy back	Gift / Inheritance / Family heirloom
In possession prior to the 2002 handgun reforms	Other
Have you previously surrendered any firearms?	Yes	No
How long has the firearm been in your possession?	years
Gender:	Male	Female	Non-Binary	Other
Age:	18 - 24	25 - 34	35 - 44	45 - 54	55 - 64	65+
How did you hear of the Amnesty?
Newspaper	Digital media	Word of mouth
Magazine or newsletter	Other reason
PART C: TO BE COMPLETED BY THE SAPOL RECEIVING OFFICER
Details confirmed with FCS?	Yes	No	If ‘No’ – record details in comments.
PPMS Number:	/	Item:
Scanned and emailed to Firearms Branch:	Yes	No
Surrendered by Owner?	Yes	No	If ‘No’ – give explanation why the person surrendering is not the owner.
Comments:
Name:	Rank:	ID:
Location:	Signature:	Date:	/ /
PART D: SAPOL ARMOURY USE ONLY
BIN NUMBER: