Firearms Form.xlsx - Kiwi Regional Airlines

Please complete all details in Sec2ons A, B and C
Please read and complete the declara2on in Sec2on D
Please keep this form with the related e-­‐2cket; you will need it at check-­‐in
A new form is required for each one way journey.
A. Passenger details
First name
Special Informa2on
Flight details
Flight no.
Flight date
Check-­‐in Staff signature
Check-­‐in staff no.
Firearm details
Firearm Serial No.
NZ (or other) Firearms Permit No.
Firearm Make:
Firearm Type:
Baggage Tag No.
Firearm Model:
Ammuni2on Descrip2on
Ammuni2on Quan2ty
B. Passenger Declara2on (to be completed before Departure, by passenger)
"I cer2fy that the above details are correct and accurate, and understand that the item may not be carried if false informa2on is provided to the airline. I also confirm that the firearm which I have surrenderede for carriage was in a safe and unloaded state, and that any ammuni2on is packaged correctly, and stored seperately from the firearm."
Passenger Name:
Passenger Signature
Date: ………../…………/……………
C. Arrival Agent Declara2on (to be completed by staff when returning firearm)
"I cer2fy that to the best of my knowledge the above details are correct, and that the following has been completed, and is correct."
-­‐ Declared firearm serial number has been checked and verified against cer2ficate.
-­‐ The passenger is the firearm cer2ficate holder and the above signature is a true reflec2on of that.
-­‐ The passenger has provide a suitable photographic proof of iden2ty.
-­‐ The firearm has been returned to the cer2fied holder.
Agent Name:
Agent Signature:
Date: ………/………………./……………
If you need help comple2ng this form, or you need another blank form sent to you, please contact KRA.
Ph. +64 7 4445020 (Reserva2ons)