FORMAT APPLICATION FOR REGISTRATION OF GAME FARM

							 (Issued in terms of the provisions of the National Environmental Management: Biodiversity Act
                                       2004, Act 10 of 2004)


                       APPLICATION TO REGISTER A GAME FARM
A.     TYPE OF APPLICATION:
NEW REGISTRATION             RENEWAL            AMENDMENT
IN CASE OF RENEWAL OR AMENDMENT, PROVIDE THE FOLLOWING:
REGISTRATION NR:                    CURRENT CERTIFICATE NR:

B.     APPLICANT (REGISTERED OWNER OF GAME FARM) DETAILS:
 NAME:
 IDENTITY OR PASSPORT NO:
 TEL NR (H):                                        TEL NR (W):
 CELLULAR:
 FAX NO:
 E-MAIL:
 POSTAL ADRESS:                                 PHYSICAL ADDRESS:




C.    PERSON TO UNDERTAKE THE ACTIVITIES IF NOT THE SAME AS APPLICANT:
 NAME:
 IDENTITY OR PASSPORT NO:
 TEL NR (H):                           TEL NR (W):
 CELLULAR:
 FAX NO:
 E-MAIL:
 POSTAL ADRESS:                     PHYSICAL ADDRESS:
D.      FACILITY DETAILS:
 REGISTERED FARM NAME AND NUMBER:

 PORTIONS (IF APPLICABLE):
 SIZE (IN HA) OF GAME FARM:
 PHYSICAL ADDRESS OF GAME FARM:




E.      RESTRICTED ACTIVITIES TO BE UNDERTAKEN ON GAME FARM:




F.      SPECIES INVOLVED:
 SCIENTIFIC NAME            COMMON NAME                   POPULATION      MARKINGS
                                                          SIZE            (WHERE
                                                                          APPLICABLE)




G.      ADDITIONAL INFORMATION TO BE SUBMITTED – REFER TO ATTACHED
        ADDENDUM




……………………………………………..                         ………………………………………
Signature of applicant                              Date of application




PERMIT COLLECTION: **PLEASE INDICATE WHETHER YOU WILL**
COLLECT YOUR PERMIT              RECEIVE BY POST
                                 (please provide postal
                                 address)


    The Department cannot be held responsible for the loss of a permit in the
     post, if requested to be posted.
           H.      OFFICIAL USE
           ADDITIONAL INFORMATION ATTACHED:
           ADDITIONAL INFORMATION SUFFICIENT:
           IF NOT, INFORMATION REQUIRED:




           I.      PERIOD OF VALIDITY OF PERMIT
           FROM:                                        TO:
                         (dd/mm/year)                                (dd/mm/year)




     NAME OF INSPECTION                 SIGNATURE OF            DATE:         APPROVED / REFUSED
     OFFICIAL                           INSPECTION OFFICIAL
     IF APPROVED, REGISTRATION NUMBER ALLOCATED:
     REASONS FOR REFUSAL:




NAME OF PERMIT     SIGNATURE OF            DATE:       AMOUNT   RECEIPT       APPROVED / REFUSED
OFFICIAL           PERMIT OFFICIAL                     PAID     NR
IF APPROVED, REGISTRATION NUMBER ALLOCATED:
REASON FOR REFUSAL:
DATE STAMP:
       ADDENDUM – ADDITIONAL INFORMATION REQUIRED


Information relating to management of populations of listed threatened or protected
species & the game farm:


(a)   Details of the number and age (if known or appropriate) of males and females of
      each listed species currently on game farm.
(b)   Details relating to fencing. The certificate of adequate enclosure or comparable
      document as issued by the provincial authority must be attached to the application
      form.
(c)   Past, current and expected annual production of offspring and, where possible,
      information on the number of females producing offspring each year.
(d)   An assessment of the anticipated need for, and source of, additional specimens to
      augment the breeding stock to increase the genetic pool of the population in order to
      avoid deleterious inbreeding.
(e)   Detailed description of the marking methods used (if any).
(f)   Details regarding measures / strategies to prevent hybridisation.
(g)   Description of the strategies used by the game farmer, or other activities, that
      contribute to improving the conservation status of wild populations of the species.




                              *********************************
Application processing fee: (Not refundable)              R1000.00

Banking Details

Bank: FNB
Account Name: GPG DACEL Cost Recovery
Account Number: 62299351446
Branch Name: Global Transactional Services Johannesburg
Branch Code: 255005
Type of Account: Business

No cash or cheques will be accepted at the Department’s Services Centres

Please contact, tel: (011) 355 1207 for further details
Fax: 011 355 1239/1100