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dangerous wild animals application form

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					                  Dangerous Wild Animals Act 1976
      Application for Licence to Keep Dangerous Wild Animal(s)
TO the Borough of Newcastle-under-Lyme

I/WE ..............................................................................................................................................................

OF          ............................................................................................................................................................

            .................................................................................... Telephone/Fax No……………………………..

I HEREBY APPLY for a LICENCE TO KEEP DANGEROUS WILD ANIMAL(S) under the provisions of the
Dangerous Wild Animals Act 1976 at the premises of which particulars are given below.


                                                         PARTICULARS OF PREMISES †

1. Postal address (including Post Code)


2. Description and dimensions of
   accommodation to be used:

3. Species of animal to be kept
   (give scientific name if possible)


4. Numbers of animals to be kept                                           Male                                   Female


5. Is it intended to breed or attempt to                                   YES / NO
   breed from these animals?

6. Description of type of food to be
   supplied and source

7. Details of Insurance Policy held to cover                               Company:
   liability for damage caused by animals (This                            Policy No.
   Policy must be produced to an Inspecting                                Expiry Date:
   Officer)                                                                Amount Insured:


I HEREBY DECLARE that I am over 18 years of age and not disqualified by being convicted of any offence
at any time under the Animal Welfare Act 2006, Protection of Animals Acts 1911 to 1964, the Protection of
Animals (Scotland) Act 1912, the Protection of Animals Act 1934, the Pet Animals Act 1951, the Animal
Boarding Establishments Act 1963, the Riding Establishments Acts 1964 and 1970 or the Breeding of Dogs
Act 1973.
A fee of ‡               £ .                                   accompanies this application

Dated                                                                       (Signed) ……………………………………………………………
                                                                                 ** ……………………………………………………………
‡ This fee is such sum as, in the authority’s opinion, is sufficient to meet the direct and indirect costs which they may incur as a
  result of this application.
** State capacity, if applicant signing on behalf of a Company or Partnership.

                                          Executive Director – Operational Services, Environmental Health Division
                                                   Newcastle-under-Lyme Borough Council, Civic Offices
                                                  Merrial Street, Newcastle-under-Lyme, Staffs. ST5 2AG
FOR OFFICIAL USE ONLY                          DATE OF INSPECTION ………………………………………


RECOMMENDATION ………………………………………………………………………………………………………………………………

Date reported to Committee / Council and Decision …………………………………………………………………………………………….

No. of Licences Issued …………………………………………..

Entered in Register ………………………………………………. Date ……………………………………………………………

Ref …………………………………………………………………..




                               Form should be returned to:

         Executive Director – Operational Services, Environmental Health Division
                  Newcastle-under-Lyme Borough Council, Civic Offices
                 Merrial Street, Newcastle-under-Lyme, Staffs. ST5 2AG

				
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posted:11/28/2011
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