Wildlife and Countryside Act 1981 (as amended)
Information for completion of an application form:
1. Please complete in BLOCK CAPITALS (* delete as applicable)
2. Please answer all questions in detail. Uncompleted questions will mean delays in your application being processed.
3. All applicants should read the Notes for Guidance ‘Licensing arrangements for the issue of licences to kill or take birds (non-piscivorous)’
1. / a) /
Name of applicant
Title (e.g. Mr, Mrs, Miss, Ms) / Initials / SurnameBusiness title (if appropriate)
b) / Address of applicant
Postcode
Contact Telephone number (incl. national dialling code):
Mobile number:
Email address:
2 / Previous applications
a. / Have you applied for a licence to kill/take birds or use prohibited methods before? / YES / NO
b. / If YES, for which species and/or methods
c. / Date of most recent application
d. / Was the licence granted / YES / NO
e. / If YES please give the licence reference number
3 / Full postal address of the land where the problem is occurring
4 /
Precise location(s) of the site where action is proposed. If appropriate include field number(s), OS Grid references etc.
/NB Please attach a map of suitable scale showing the area where the problem is occurring. Maps are not normally required for applications relating to domestic, commercial or industrial properties
5 /a)
/Are you the owner or occupier of the land referred to at question 3 above?
/ YES / NOb)
/If ‘NO’. give the position you hold in relation to this land
/NB Where you are not the owner or occupier you should attach the owner or occupier’s written consent for you to make this application.
6
/Application to kill or take birds within a National Nature Reserve (NNR) or Site of Special Scientific Interest (SSSI), Special Area of Conservation (SAC), Special Protection Area (SPA) or Ramsar site
(NB: Please read Section 4.3 of the Notes for Guidance (WCA21) before completing this question)/
delete as appropriate
/a)
/Will the proposed action be in an area covered by an NNR, SSSI, SAC, SPA or Ramsar?
/ YES / NO/
b)
/Will the proposed action be in an area adjacent to an NNR, SSSI, SAC, SPA or Ramsar?
/ YES / NO/
c)
/If ‘YES’: have you consulted in writing with Natural Resources Wales (NRW)?
/ YES / NO/
d)
/In the box below, please give either the outcome of the owner’s or occupier’s consultation or the reason why you the owner or occupier have not consulted and enclose any relevant correspondence
7
/Nature of the problem
/a)
/Bird species
//
b)
/Give details of the nature and extent of the problem being caused or likely to be caused
/c)
/Time of year when the problem occurs
/d)
/Approximate number of birds causing the problem
/8 /
Preventative measures taken
delete as appropriate
a)
/Have any measures been taken to prevent the problems outlined at question 7 above?
/ YES / NOb)
/If ‘YES’, provide details of the methods already tried and explain why you do not consider them sufficient. (e.g. scaring, proofing, shooting in the open season)
/c)
/If ‘NO’ explain why preventative control measures have not been taken
/9 /
Proposed licenced action
a)
/Bird species
/b)
/Nature of proposed action (e.g. shooting, egg oiling, nest destruction, pricking, relocating, cage trapping, mist netting, other methods such as stupefying drugs, CO2 etc.)
/c) /
Period of proposed action (which months)
/10 /
Authority to shoot
Up to six people (including the licensee) may be authorised to shoot birds under a licence.It is your responsibility to ensure that you have the right to shot
Please list below the names and contact telephone numbers of all persons other than the licensee who are authorised to shoot (maximum of 5).
Name of authorised person
/Contact telephone number
11 /Mist netting and the use of CO2 stupefying baits (alphachlaralose) please read section on guidance notes (If you do not wish to use these methods go to section 12.
/a.
/Which method do you wish to use?
//
b.
/Have you within the past two years passed a formal training course on the above prohibited method that included a practical content
/ YES / NO/
c.
/If YES please state the date and title of the course and the trainer (company or individual as appropriate).
//
d.
/If you have not passed a training course within the last two years, have you previously held a licence and undertaken at least one treatment using the method stated in (a) above within the past two years
/ YES / NO12 /
Convictions
Have you, or any of the persons to be authorised by you to carry out the proposed work for you, ever been convicted of an offence under the Wildlife and Countryside Act 1981 (as amended), The Protection of Badgers Act 1981, the Food and Environment Protection Act 1985 or the Protection of Animals Acts 1911-27?
/delete as appropriate
YES / NOIf ‘YES’, please give details
/13 /
Handling of your Information
The information requested in this application form will capture personal data about you – for example, your name and address. Your personal data will be managed and used by the NRW in accordance with the Data Protection Act 1998. For more information please see the Notes for Guidance.
Do you give your consent to the disclosure of information provided by you in connection with this application. Your personal and financial information not relating to the environment will notbe disclosed
YES / NO
14 /
Declaration
I have read the Notes for Guidance ‘Arrangements for the issue of licences to kill or take mammals’. I declare that the particulars given are correct to the best of my knowledge and belief, and I apply for a licence in accordance with these particulars.
/Signature of applicant
/ /Date
//
For electronic applications please insert an electronic signature above or place an x in the box opposite to confirm agreement with the declarations above.
//
Name in BLOCK LETTERS
/ // WARNING: Any persons who in order to obtain a licence knowingly or recklessly makes a statement or declaration or furnishes a document or information which is false in a material particular is guilty of an offence under the Wildlife and Countryside Act 1981 and may be liable to criminal prosecution. Any person found guilty of such an offence would be liable to a fine not exceeding £2,500.
/
Please return this completed form to
Species Protection Team,
Natural Resources Wales,
Maes y Ffynnon,
Penrhosgarnedd,
Bangor,
LL57 2DW
or e-mail your completed form to
Tel. 03000653000
WCA20