All licence application forms by 3pWS7hv

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									                                                                          Licensing Section
                                                                   Scottish Natural Heritage
                                                                          Great Glen House
                                                                             Leachkin Road
                                                                                  Inverness
                                                                                    IV3 8NW
                                                                              01463 725000
                                                                   LICENSING@snh.gov.uk



LICENCE APPLICATION FORM
The Wildlife and Countryside Act 1981 as amended by the Nature Conservation
(Scotland) Act 2004 Section 16(1)(k)
Application for a licence to kill Resident Greylag Geese

Instructions to applicant – please follow carefully.

1. Please complete all relevant sections of the application form. If you need assistance,
please contact your local SNH office.

2. Print off the whole form and sign and date it. Note we cannot process unsigned
application forms.

3. Send the completed and signed application form by post to the above address.
Additional documents can be appended, but we would prefer to receive these electronically
(see below)

4. You will receive an email acknowledgement once your application is received by SNH’s
Licensing Section.

5. When you have received your acknowledgement please email any supporting documents
to LICENSING@snh.gov.uk ensuring that your covering email includes the name of the
applicant.

Please note

SNH will hold your contact details on our Customer Database. All licence application forms, licences issued
and correspondence relating to licensing decisions will be stored in our electronic filing system. We will use
this information to undertake licensing functions. To do this we may have to discuss applications with relevant
third parties.
We manage personal information in accordance with the Data Protection Act 1998. The Act gives individuals
the right to know what data we hold on them, how we use it and to which third parties it is disclosed.
Where appropriate we may use your information within SNH for other purposes for example: sending you our
magazine, inviting you to an event or asking for your feedback




Version 1.1 January 2012                                                                              1
                                                                     Licensing Section
                                                              Scottish Natural Heritage
                                                                     Great Glen House
                                                                        Leachkin Road
                                                                             Inverness
                                                                               IV3 8NW
                                                                         01463 725000
                                                              LICENSING@snh.gov.uk


LICENCE APPLICATION FORM
The Wildlife and Countryside Act 1981 as amended by the Nature Conservation
(Scotland) Act 2004 Section 16(1)(k)
Application for a licence to kill Resident Greylag Geese

Section A – Applicant details
Please give the complete details of the person who will hold the licence.
Title                             SELECT     please select one
Surname
First name
                  House name or
                  number
                  Street
                  District
Address           City or Town
                  County
                  Post Code
                  Country
                                  Is this your Home Address       Work Address
Date of birth (dd/mm/yyyy)
Home telephone number
Work telephone number
Mobile number
E-mail address
Organisation & position
(if applicable)

Farm CPH Number




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Farm Details if different from above
            Farm Name




Address


            Post Code
            County
            Farm CPH
            Number

Nature of applicants interest ie owner/occupier, tenant, landlord, other




Do you have written permission to shoot wild geese on the property?

Yes         No




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Section B - Reason for Licence Application

(a) Please describe damage caused, or likely to be caused, by resident greylag
    geese.

 Kind of Crop      Approx area in   field Identifier (eg   Number of birds      Is the area
                     hectares        AB/12345/12345)         involved in     wholly or partly
                                                             causing the      in an Special
                                                               damage        Protection Area




(b) Have you had a licence to kill resident greylag geese previously?

Yes          No

(c) Have your crops been seriously damaged in previous close seasons?

Yes          No

(d) If “No” please state why you expect serious damage during this closed
season.




(e) If “Yes” please state what measures were taken to prevent serious damage
occurring?




(f) Was killing or taking an essential part of the protective measures?

Yes          No


(g) Are you a member of the local Goose Management Scheme?

Yes          No




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(h) Will you be undertaking the shooting yourself?

Yes          No

(i) If no please list the names, addresses and contact numbers of those who
    will be carrying out the shooting on your behalf.


Title                      SELECT       Title            SELECT
Surname                                 Surname
First name                              First name
House name or                           House name or
number                                  number
Street                                  Street
District                                District
City or Town                            City or Town
County                                  County
Post Code                               Post Code
Country                                 Country
Contact tel no                          Contact tel no



Title                      SELECT       Title            SELECT
Surname                                 Surname
First name                              First name
House name or                           House name or
number                                  number
Street                                  Street
District                                District
City or Town                            City or Town
County                                  County
Post Code                               Post Code
Country                                 Country
Contact tel no                          Contact tel no




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Section C – Previous licences

If you have held a licence previously, please give details below.
Licence number                                        Country:   SELECT
Brief detail of most recent /
relevant licence held




                                        Declaration


Applicants should note that it is an offence under Section 17 of the Wildlife
and Countryside Act 1981 and under Regulation 46 of the Conservation
(Natural Habitats &c) Regulations 1994 to knowingly or recklessly provide
false information in order to obtain a licence.

   I understand that failure to comply with any conditions included on any
    licence granted in respect of this application may constitute an offence.

   I declare that the particulars given in this application and any
    accompanying documents are true and accurate to the best of my
    knowledge and belief, and I apply for a licence in accordance with these
    particulars.

   If a licence is granted, I agree to send to SNH a written report of the
    licensed activities within one month of the expiry of the licence.




DATE:                      SIGNATURE:




This application must be printed and signed by the applicant and a hard copy must
be posted into the Licensing Team at GGH. Digital signatures are not accepted at
this time.


Do you wish to receive our quarterly magazine?                   Yes

Do you wish to receive other appropriate mailings from us?       Yes




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