ANIMAL BOARDING ESTABLISHMENTS ACT 1963 APPLICATION FOR A LICENCE

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					                ANIMAL BOARDING ESTABLISHMENTS ACT 1963

                         APPLICATION FOR A LICENCE
                TO KEEP AN ANIMAL BOARDING ESTABLISHMENT



1.        NAME                                    ...................................................................................................
          (BLOCK CAPITALS)
          ADDRESS                                 ...................................................................................................

                                                  ................................................. POST CODE...........................

          TELEPHONE NUMBER                        ...................................................................................................



2.        NAME OF BOARDING
          ESTABLISHMENT                           ...................................................................................................

          ADDRESS                                 ...................................................................................................

                                                  ................................................. POST CODE...........................

          TELEPHONE NUMBER                        ...................................................................................................


3.        Are you disqualified from:

          (a)       keeping a pet shop                                                                                                          YES / NO

          (b)       keeping an animal boarding establishment                                                                                    YES / NO

          (c)       keeping a dog                                                                                                               YES / NO

          (d)       having the custody of animals                                                                                               YES / NO


I apply for a licence to keep an animal boarding establishment from date of issue / 1 January 20__

* Delete as appropriate. A licence may run either from its date of issue or from 1 January next and
remains valid for the remainder of the year in which it is issued.

I / We enclose herewith the sum of £ being the amount of the fee payable on the licence applied for.
 Cheques should be made payable to Borough of Reigate and Banstead.


Date: ...................................         Signature:             ..................................................................

Please return to:                           Licensing Officer, Reigate & Banstead Borough Council, Town Hall,
                                            Castlefield Road, Reigate, Surrey, RH2 0SH.


                                                                                                                  C:\DOCUME~1\MarkhPet\LOCALS~1\Temp \LIC057~1.DOC

				
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Description: ANIMAL BOARDING ESTABLISHMENTS ACT 1963 APPLICATION FOR A LICENCE