AFFIDAVIT OF SURRENDER OF FIREARMS

I, _____________________, of legal age, single/married, presently residing at

__________________________, after having duly sworn to in accordance with the
law do hereby depose and state:

That this ____ day of _____, 2023, I voluntarily went to the [PNP STATION],
located at __________________ to personally submit or surrender the firearm with
registration number __________ valid until ______________ and licensed under
______________ in my possession;

That upon surrender of subject firearm, it is hereby acknowledged that the

[PNP Station] assumes custody and responsibility for such firearm in accordance
with the relevant laws and regulations;

That, I executed this affidavit to attest the truthfulness of the above narrated
facts and to support my full interest to surrender. I hereby affix my signature this
_____ day of ______, 2023 at ________________________________.

________________________
Affiant

SUBSCRIBED AND SWORN to before me this ____ day of ___________,

2023 at ___________________________. Further, I certify that I personally
examined the herein affiant that he voluntarily executed and fully understood his
statements.

________________________
Administering Officer

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