APPLICATION FOR A LICENCE TO KEEP

DANGEROUS WILD ANIMALS

This application is made under the Dangerous Wild Animals Act 1976

New application Renewal application (please tick)

Please use BLOCK CAPITALS.

1. Applicant details
Date of Birth
Title (Mr / Mrs / Miss / Ms)
Forename
Surname
Address*
Post code
*If a Body Corporate, name of Body & Registered address
Email
Telephone No
Alt Telephone
Fax
Mobile
*if a Body Corporate, name of Body and Registered Address
2. Animal details
Please provide details for the following:
Type or species of animals to be kept (Give scientific name if possible)
Numbers to be kept: / Male / Female
Is it intended to breed, or attempt to breed from these animals? Yes No
3. Premises where the animals are kept
Address
Postcode
Email
Mobile
Please provide details for the following:
§  Description and dimensions of the accomodation to be used (Continue on a separate sheet in necessary)
§  A description of type of food to be supplied and source
§  Details of insurance policy held to cover liability for damage caused by animals / Name of Company
Policy Number
Amount / Expiry date
§ 
4. Your Signature
On signing this form you declare that any information you have provided is true and complete in every respect. The giving of false information may result in revocation of the licence and possible enforcement action taken against you that may result in prosecution.
I declare my answers to the above questions to be correct in every respect and that I have not been disqualified by being convicted of any offence at any time under the Protection of Animals Act 1911 –1964, The Protection of Animals (Scotland) Act 1912, The Protection of Animals Act 1934, The Pet Animals Act 1951, The Animal Boarding Establishments Act 1963, the Riding Establishments Acts 1964 and 1970 or the Breeding of Dogs Act 1973
Signature Date

Notes

1. A licence may be granted to an individual over the age of eighteen

2. A licence is valid from the date of issue.

An invoice will be sent to you for payment. The fee for a new DWA License application & renewal is £98.35

Data Protection Act 1998
The Council (the Data Controller) will use and manager the personal information supplied on this form for the purpose of processing your application in accordance with that set out in the above Act.
The information that you supply will be secure and protected against unauthorised access and use.
If any of the information supplied, is to be processed outside of the Community Safety Team of West Dorset District Council we will obtain your consent to do so. If any information is of a sensitive nature (i.e health matters) we will always obtain your consent before it is processed.
You have the right to see personal information that we hold about you. For further details contact the Councils Corporate Data Protection Officer,

Updated 11.04.2016