Fillable 2020.02.14 RIAMS Animals For Exhibition Application Form Keeping or training of animals licence application form - Eastbourne Borough Council

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2020.02.14 RIAMS Animals For Exhibition Application Form Keeping or training of animals licence application form - Eastbourne Borough Council

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  • 29 check-boxes
  • 88 other fields

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Page 1 of 5
The Animal Welfare (Licensing of Activities Involving Animals) Regulations 2018
Application for a licence to carry on the activity of keeping or training animals for
exhibition
1
Reference number
1.1
System reference number
1.2
Your reference
Please complete all the questions in the form.
If you have nothing to record, please state ‘not applicable’ or ‘none’
2
Agent
2.1
Are you an agent acting on behalf of the
applicant?
Yes No If ‘no’, go to 3
2b
Further information about the agent
2.2
Name
2.3
Address
2.4
Email
2.5
Main telephone number
2.6
Other telephone number
3
Applicant details
3.1
Name
3.2
Address
3.3
Email
3.4
Main telephone number
3.5
Other telephone number
3.6
Applying as a business or organisation,
including a sole trader?
Yes No
3.7
Applying as an individual?
Yes No
4
Applicant business
4.1
Is your company registered with
Companies House?
Yes No If ‘no’, go to 4.3
4.2
Registration number
4.3 Is your business registered outside the
UK?
4.4 VAT number
4.5 Legal status of the business
4.6 Your position in the business
4.7 The country where your head office is
located
Page 2 of 5
4
Applicant business
4b
Business address – this should be your official address, i.e. the address required of you by law to
receive all communication
4.8
Building name or number
4.9
Street
4.10
District
4.11
City or town
4.12
County or administrative area
4.13
Postcode
4.14
Country
Please complete all the questions in the form.
If you have nothing to record, please state ‘not applicable’ or ‘none’
5
Type of business/performance (please tick)
5.1
TV/film/social media
5.2
Theatre
5.3
Circus using domestic animals
5.4
Exhibiting animals
5.5
Animal encounters
5.6
Birds of prey shows/exhibits
5.7
6
Application details
6.1
Have you been registered/licensed before
Yes No If new, go to 6b
6.2 Local authority where registered/licensed
6.3 Give details of registration e.g. type and
numbers of animals, type of performance
or exhibition
6b
Further information about the applicant
6.3
Stage name (if any)
6.4
Nationality
6.5
Date of birth
7
Animals to be trained
7.1 Name of premises/trading name
7.2 Address of premises
7.3 Telephone number of premises
7.4 Email address
8
Kinds of animal to be trained and the number of each kind
8.1
Kind of animal
8.2. Number
8.3
Is there another kind of animal?
Yes/No
If ‘yes’, please include details in the
Additional Information section at 15.1
9
Kinds of animal to be exhibited/encounter and the number of each kind
9.1
Kind of animal
9.2. Number
9.3
If you intend to exhibit further kinds of animals please attach a separate list of these animals and the
numbers of each.
Page 3 of 5
10
Proposed performance or encounter
10.1
Describe the nature of the performance(s)
in which the animals will be exhibited or
for which they are to be trained,
mentioning any apparatus which is used
for the purpose of the performance. The
description must be sufficient to give a
general idea of what is done by the
animals taking part in the performance.
If it is an animal encounter, please give
details of what type of encounter and
where these are to take place
10.2.
Approximate duration of the
performance(s)
10.3
Number of times the performance will be
given in one day
10.4 How will the animals be transported?
10.6
Where are the animals to be kept when
not performing or being exhibited?
11
Veterinary surgeon
11.1 Name of usual veterinary surgeon
11.2
Company name
11.3 Address
11.4 Telephone number
11.5
Email address
12
Emergency keyholder
12.1 Do you have an emergency keyholder? Yes/No If ‘no’, go to 13.1
12.2
Name
12.3
Position/job title
12.4
Address
12.5
Daytime telephone number
12.6 Evening/other telephone number
12.7
Email address
12.8
Is there another keyholder?
Yes/No
If ‘yes’, please include details in the
Additional Information section at 15.1
13
Public liability insurance
13.1 Do you have public liability insurance? Yes/No If ‘no’, go to question 13.6
If ‘yes’, please provide details of the policy
13.2 Insurance company
13.3 Policy number
13.4
Period of cover
13.5 Amount of cover (£5 million minimum required)
13.6
Please state what steps you are taking
to obtain such insurance
14
Disqualifications and convictions
Has the applicant, or any person who will have control or management of the establishment, ever been
disqualified from:
14.1
Keeping a pet shop?
Yes/No
14.2
Keeping a dog?
Yes/No
Page 4 of 5
14
Disqualifications and convictions
14.3
Keeping an animal boarding establishment?
Yes/No
14.4
Keeping a riding establishment?
Yes/No
14.5
Having custody of animals?
Yes/No
14.6
Has the applicant, or any person who will have control or
management of the establishment, been disqualified or
convicted of any offences under the:
Animal Welfare Act 2006
Animal Welfare (Scotland) Act 2006
Dangerous Dogs Act 1991
Any other legislation listed in Schedule 8 of the LAIA
Regulations 2018?
Yes/No
14.7
Has the applicant, or any person who will have control or
management of the establishment, ever had a licence
refused, revoked or cancelled?
Yes/No
14.8
If ‘yes’ to any of these questions, please provide details
15
Additional details
Please check local guidance notes and conditions for any additional information which may be required
15.1
Add
itional information which is required or may be
relevant to the application
Standard payment and declaration section
16
Payment
16.1
Payment must be made at the time of making the application
16.2
Confirm date payment of fee made and
how made e.g. online. Include reference
number
17
Statutory guidance
All applicants to tick that they have read the applicable statutory guidance and conditions
17.1
Selling Animals as Pets
17.2
Boarding for Cats
17.3
Boarding in Kennels for Dogs
17.4
Day Care for Dogs
17.5
Home Boarding for Dogs
17.6
Keeping or Training Animals for
Exhibition
17.7
Hiring Out Horses
17.8
Breeding Dogs
18
Additional information
Please attach the following Information - ALL INFORMATION IS REQUIRED
18.1
A Basic DBS (Dated within 3 months of
the application date)
18.2
Right to Work (Passport, Birth
Certificate, ID Card or Home Office
Document)
Page 5 of 5
18
Additional information
18.3
Proof of Planning Permission
(including GBC Reference number)
18.4
A plan of the premises (including
measurements)
18.5
Insurance policy (minimum £5 million)
18.6
Standard operating procedures
18.7
Emergency response plan
18.8
Infection control procedure
18.9
Qualifications
18.10
Training records
18.11
Other documents may be required
specific to the type of activity
19
Declaration
19.1
This section must be completed by the applicant. If you are an agent, please ensure this section is completed
by the applicant.
19.2
I am aware of the provisions of the relevant Act, Regulations and Statutory Guidance.
The details contained in the application form and any attached documentation are correct to the best of my
knowledge and belief.
I understand that a person authorised by the Council will inspect the premises before a licence is issued.
I understand that a person authorised by the Council may inspect the premises either by appointment or
unannounced at any reasonable time.
I understand that a person authorised by the Council may take photographs or video footage whilst carrying out
inspections or visits to the premises.
I am aware that a fee is payable for this licence application.
I accept that all veterinary fees incurred by the authority in respect to the licence application will be recoverable
at cost.
I accept that in the event of my application being refused or I withdraw it, I will not be refunded the application
fee or any part thereof under any circumstances.
I apply under the above legislation for a licence to carry on the activity of keeping or training of animals for
exhibition from the above premises.
I accept that on occasion the Council has to provide information to third parties in response to requests made
under the Environmental Information Regulations 2004, Data Protection Act 1998 and Freedom of Information
Acts.
19.3
Signing this box indicates you have read
and understood the above declaration
19.4
Full name
19.5
Capacity
19.6
Date
The information you provide on this form will be used by Guildford Borough Council for licensing purposes. We
may share your information and make any other necessary enquiries regarding your application with other
departments and statutory organisations in relation to the application. Your personal information will be
processed in line with Data Protection legislation and we will not disclose information about you to anyone
outside the Council unless the law permits or requires us to.
We will retain your data for as long as it is required for our administrative use, after which it will be securely
disposed of.
If you believe the data we process on you is incorrect you may request to see this information and, if
necessary have it corrected or deleted. If you wish to raise a complaint you can contact our Data Protection
Officer at the address below. If you believe we are processing your data lawfully you can complain to the
Information Commissioner’s Office (https://ico.org.uk/). Further details are available on our website –
https://www.guildford.gov.uk/dataprotection, or from the Information Rights Officer, Guildford Borough Council,
Millmead House, Millmead, Guildford, Surrey, GU2 4BB (email:foi@guildford.gov.uk).
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2020.02.14 RIAMS Animals For Exhibition Application Form Keeping or training of animals licence application form - Eastbourne Borough Council

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Completed 7 July 2020

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