SSAA (NSW) Inc

STATEMENT OF ATTAINMENT

SSAA SAFE SHOOTING COURSE

(An approved course meeting the national standards for firearms safety training
for category A, B, C, D and G firearms)

Certificate No.
I hereby certify that the person whose details appear on this certificate has completed the SSAA Safe

E
Shooting Course and has been assessed as competent.

..... ./...... ./2 ........

CANDIDATE DETAILS:
PL
Signature of Assessor Date

Full Name: ............................................................................................

Address: ..............................................................................................

Town or Suburb: ................................................... Postcode: ..................

M
Date of Birth: .......................... Driver's Licence Number: ............................

Minor's Permit Number (ifheldj: ..............................Expiry Date: ............... .

SA

ASSESSOR/ASSESSMENT DETAILS:

Assessor Name: ......................................................................................

Commissioners Permit/Assessor Approval number: ............................................

Club for which Assessment conducted: ...........................................................

Premises used for Assessment: .....................................................................

Date of Assessment: ......./. ...../2 ......

SSAA (NSW) Inc, PO Box 1001 St Marys NSW 1790

Tel: (02) 8889 0400 Fax: (02) 8889 0442

Candidate to retain yellow copy and send original white certificate to the Firearms Registry with their
licence application. Assessor to retain green copy and send pink copy to SSAA Training.