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Form D Part 1: Application for a permit to exhibit a prescribed speciesExhibited Animals Protection Act 1986 S25

This form can be used to apply for a permit to exhibit an animal of a prescribed species. Prescribed species are listed in Schedule 2 of the Exhibited Animals Protection Regulation 2010. If you are not already authorised to exhibit animals in New South Wales, you should submit this form in conjunction with a completed Form A or Form B.

1. Applicant details

Applicant name
Trading name
Authority number
Licence, Approval or Permit number / If you are not currently authorised to exhibit animals, leave this question blank.

2. Species

A separate application form should be submitted for each Prescribed Species to be exhibited.

Common name of species / Scientific name of species / Numbers
M / F / U / Total

It is important to note that the possession of the same species under both an Exhibited Animals Protection Act 1986 authority and a National Parks and Wildlife Act 1974 Animal Keepers Licence is prohibited.

3. Supporting documents

To support your application, attach the following:

Attachment / Supporting document details
A / Expertise and experience of the applicant, or staff of the applicant’s organisation, with the keeping of this or similar species.
Résumés of curators, keepers and veterinary support indicating experience with this or similar species and references from exhibitors already authorised to exhibit this species may aid your application.
(Mark as Attachment A)
B / Housing details
If new construction proposed – attach a completed application (Form G Application for approval to construct or alter an animal enclosure or facility) with the relevant fee.
If existing housing to be used - indicate the species previously approved for the enclosure and provide diagram(s) indicating size, materials, safety features (e.g. stand-off barriers and double-door entry) and furniture/habitat setting. Photographs may also assist. (Mark as Attachment B)
C / A diet sheet detailing the content and frequency of the diet to be fed to this species.
(Mark as Attachment C)
D / A photocopy of the front page of all relevant exhibit standards.
(Mark as Attachment D)
E / Wording that will appear on the identification sign for this species.
(Mark as Attachment E)

Note: For species listed as Category 2 in Schedule 1 of the Non Indigenous Animals Regulation, attach a completed Form D – Part 2: Supplementary Information in Support of an Application to Acquire a Non-Indigenous Species for Exhibition.

4. Declaration

I have read and understood the relevant standards and undertake to exhibit the animals in accordance with those standards.

I consent to staff of the Department of Primary Industriescontacting any referee, person or organisation referred to in this application as part of the assessment process.

Icertify that I will not hold animals of the same species under both an Exhibited Animals Protection Act 1986 authority and an Animals Keepers Licence issued under the National Parks and Wildlife Act 1974.

Name
Position Title
Signature
Date

5. Fees

The lodgement fee is $23 per application.

Select payment method

Cheque
(Payable to NSW Trade & Investment) / Money order
(Payable to NSW Trade & Investment) / Credit Card
(see below)
Payment amount
Type of card / Visa Mastercard
Card no. (16 digits)
Credit card verification number (Security number)
Expiry
Cardholder’s name
Cardholder’s Signature

Any application that is not accompanied by the relevant fee(s) and supporting documents referred to in this form will be returned without further assessment.

Submit the completed form:

Either by

  • the preferred method: emailing a pdffile of the completed, signed form, attachments and credit card details to

or

  • posting the completed, signed form and attachments, including lodgement fee, to:

Licensing Clerk
Animal Welfare Unit
Department of Primary Industries
Locked Bag 21
ORANGE NSW 2800

For more information or for assistance completing the form, contact the Animal Welfare Unit on 6391 3149.

Privacy: The information collected in this form will be stored securely and used only for the purposes for which it has been collected. See our full privacy policy at

Please keep a copy of this application for your records.

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