Application for licence to keep dangerous wild animal(s)

Dangerous Wild Animals Act 1976

Type of application: *

Type of application:

Grant

Renewal

Cost for a Grant Application:

£410.00

Cost of a Renewal Application:

£385.00

Payment

Please note: You must provide payment for this after completing the form. You do this online. After clicking the submit button at the end of the form you will be taken to our secure online payment website. You can then make the required payment using either a credit or debit card. You will be charged a 1.9% surcharge if you pay using your credit card.

If you do not wish to pay online you cannot use this application form. In this case you must apply using the downloadable (PDF) version of the form, which is also available on our website.

Name of applicant

Title
If Other, please specify
Surname *
First name(s) *

Address of applicant

Prefix e.g. first floor flat.
House name/number
Street
Village/Area e.g. Scawby, Bottesford, etc.
Town
County
Post code *Please input your post code using capitals and include a space between the first and second parts e.g. DN17 5TY.

Telephone no.

Premises

Address of premises where animal(s) is/are to be kept *

Post code *

Please input your post code using capitals and include a space between the first and second parts e.g. DN17 5TY.

Species of animal(s) you plan to keep

Please provide details of the species of animal(s) you plan to keep

Species of animal to be kept *
(Please give scientific name if possible)

Numbers to be kept:

Male *
Female *
Total *

Please use the Add button to create an entry for each species you intend to keep

Is it intended to breed or attempt to breed form these animals? *

Is it intended to breed or attempt to breed form these animals?

Yes

Description and dimensions of accommodation to be used *

Description of type of food to be supplied and source *

Insurance

Details of Insurance Policy held to cover liability for damage caused by animal(s)

Company *

Policy number *

Expiry date *

Expiry date

Amount *

(Note: This Policy must be produced to an inspecting officer if required).

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 Protection of Animals Acts 1911 and 1964, the Protection of Animals (Scotland) Act 1912, the Protection of Animals Act 1934, the Pet

Dated *

Dated19 Mar 2010

Agreement: *

I agree that the information provided is correct to the best of my knowledge

If the agreement is on behalf of a Company or Partnership, state in what capacity

Contact email address

(Note: on submitting your completed form, if you have provided a valid email address above you will automatically receive a copy of your completed form).

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