INDIVIDUAL APPLICATION FOR LICENSE TO OWN AND POSSESS FIREARM

INDIVIDUAL APPLICATION FOR LICENSE TO OWN AND POSSESS FIREARMS

(LTOPF)
(To be filled out by FEO Personnel only)
LICENSE CONTROL No.: - - - TYPE OF APPLICATION:
✔ NEW
RENEWAL
TYPE OF LICENSE: TYPE 1 TYPE 2 TYPE3 TYPE 4 TYPE 5

OTHER LICENSE/S: Sports Shooter Antique Firearm Collector Gun Collector

Month
Day Year
(To be filled out by Applicant completely and legibly)
DATE : / /
PERSONAL INFORMATION

Last Name: L O R E N Z O
First Name: R O M M E L
Middle Name: Z U B I R I Qualifier:

E-Mail Address: Le m m o r _ 2 4 1 1 l o r e n z o @ y a h o o . c o m
Place of Birth: M A N I L A
Day Month Year
Date of Birth: 2 4 / 1 1 / 1 9 7 9 Gender: M F

Mobile No.: + 6 3 9 3 6 9 35 1 0 4 6 TIN: - -

Primary Address: Telephone No.: ( )

Unit No./Bldg: P h a s e 2 b l o c k 1 1 L o t 2 1
Street/Brgy: F V R b a r a n g a y P o b l a c i o n 5
City/Municipality: C a v i t e G e n m a r i a n o a l v a r e z
Region: r e g i o n 4 A Postal Code: 4 1 1 7
Next of Kin:
Last Name L O R E N Z O
First Name R O D O L F O
Middle Name P A R I N A

Mobile No.: + 6 3 9 3 6 9 3 5 1 0 4 6 Telephone No.: ( )

Qualification: ☐ Businessman ☐ Professional ☐ Private Employee ☐ PNP/AFP/Other LEAs

☐ Elected Official ☐ Gov’t Official ☐ Gov’t Employee
✔ ☐ Ret. PNP/AFP/Other LEAs
☐ Reserve AFP ☐ Ret. Gov’t Official ☐ Ret. Gov’t Employee ☐ Others
CERTIFICATION AND UNDERTAKING
I hereby certify that, pursuant to the provisions of Republic Act 10591, all statements
provided herein are true and correct. Further, I certify that I have not been convicted of any crime
involving moral turpitude, nor have I been convicted or am currently an accused in a pending
criminal case for a crime that is punishable with a penalty of more than two (2) years. Any
misdeclaration/falsity stated in this application shall be a basis for the cancellation of my license
and the revocation of the registration/s of my firearm/s and its/their eventual confiscation without
prejudice to the filing of criminal and/or civil case against me.

Rommel Z. Lorenzo
2” X 2”
Signature above printed name I.D. Photo
(White Background)
SUBSCRIBED AND SWORN to before me this day of 20
Original Photo Only
applicant exhibited to me his/her competent evidence of identity issued by No Photocopy
, bearing ID No. on 20 . No Scanned

Doc. No.:
Page No.:
Book No.:
Series of 20
NOTARY PUBLIC RIGHT THUMBMARK
(Roll thumbprint from left to right)
FEO-ILS-LTOPF-r2017-
amx