Form XIX (Under Rule 39)

License for export and re-import/import, transport and re-export of arms and ammunition.

1[***]

Name, description and residence of licensee & agent (if any) authorised for the purpose of this consignment

Licensee's place of business, if any

(Applicant)
Number of packages
Arms
Ammunition
Place of despatch, route and mode of transit

Place of destination

Name, Description and residence of consignee

Period for which the license is valid
Description
Weight in Kg. or number
Description
No.
1
2
3
4
5
6
7
8
9
10
11

1) For Transportation From:

To:

 

2) And For Re-Import From:

To:

            

From:

To:

and re-import from:

By Rail/Transport or Personally.

1) For Transportation:

 

2) For re-import:

For Transportation:

 

For re-import:

  

The ............... of .............20 ............

Date on which a copy is sent to the  
                 (a) District Magistrate/ Commissioner of Police ...........................................................
                 (b) ....................................................Arms and Ammunition Dealers,...................................... ................................................................................................................
   
The ............... of .............20 ............ Licensing Authority                                       Signature
(SEAL)
     Designation .............................................................. Place ................................................
1. Omitted by G.S.R. 1, dated 19th December, 1997 (w.e.f. 3-1-1998).