Fillable 2020.02.14 RIAMS Breeding Dogs Application Form Dog breeding licence application form - Eastbourne Borough Council

Fill Online, Printable, Fillable, Blank 2020.02.14 RIAMS Breeding Dogs Application Form Dog breeding licence application form - Eastbourne Borough Council Form

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2020.02.14 RIAMS Breeding Dogs Application Form Dog breeding licence application form - Eastbourne Borough Council

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The 2020.02.14 RIAMS Breeding Dogs Application Form Dog breeding licence application form - Eastbourne Borough Council form is 5 pages long and contains:

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  • 38 check-boxes
  • 78 other fields

Country of origin: UK
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Page 1 of 6
The Animal Welfare (Licensing of Activities Involving Animals) Regulations 2018
Application for a licence to carry on the activity of breeding dogs
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
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
Page 2 of 6
4
Applicant business
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 application
5.1
Type of application
New Renewal
5.2 Existing licence number
5a
Animals to be accommodated
5.3
Wholly indoors
W
holly outdoors
Combination of outdoors and
indoors
5.4 Breeds of dogs concerned
5.5 Number of bitches kept
5.6
Owned by the
applicant
Co-owned by the
applicant
O
n breeding terms
5.7 Provide details of the ages of bitches
kept
5.8 Number of studs kept
5.9 Owned by the
applicant
Co-owned by the
applicant
On breeding terms
5.10 Provide details of the ages of the studs
kept
5b
Further information about the applicant
5.11
Date of birth
6
Premises to be licensed
6.1 Name of premises/trading name
6.2 Address of premises
6.3 Telephone number of premises
6.4 Email address
6.5
Do you have planning permission for
this business use?
Yes/No
7
Accommodation and facilities
7.1
Details of the quarters used to
accommodate animals, including number,
size and type of construction
7.2. Exercise facilities and arrangements
7.3 Heating arrangements
7.4 Method of ventilation of premises
7.5 Lighting arrangements (natural & artificial)
7.6 Water supply
7.7 Facilities for food storage & preparation
Page 3 of 6
7
Accommodation and facilities
7.8
Arrangements for disposal of excreta,
bedding and other waste material
7.9
Isolation facilities for the control of
infectious diseases
7.10
Fire precautions/equipment and
arrangements in the case of fire
7.11
Do you keep and maintain a register of
animals?
Yes/No
7.12
How do you propose to minimise
disturbance from noise?
8
Veterinary surgeon
8.1
Name of usual veterinary surgeon
8.2 Company name
8.3 Address
8.4
Telephone number
8.5 Email address
9a
Emergency keyholder
9.1 Do you have an emergency keyholder? Yes/No If ‘no’, go to 10.1
9.2
Name
9.3
Position/job title
9.4
Address
9.5 Daytime telephone number
9.6 Evening/other telephone number
9.7 Email address
9.8
Is there another keyholder?
Yes/No
9b
Emergency keyholder
9.9 Do you have an emergency keyholder? Yes/No If ‘no’, go to 10.1
9.10
Name
9.11
Position/job title
9.12
Address
9.13 Daytime telephone number
9.14 Evening/other telephone number
9.15 Email address
9.16
Is there another keyholder?
Yes/No
10
Public liability insurance
10.1 Do you have public liability insurance? Yes/No If ‘no’, go to question 10.6
If ‘yes’, please provide details of the policy
10.2 Insurance company
10.3 Policy number
10.4 Period of cover
10.5 Amount of cover (£5million minimum required)
10.6
Please state what steps you are taking to
obtain such insurance
Page 4 of 6
11
Disqualifications and convictions
Has the applicant, or any person who will have control or management of the establishment, ever been
disqualified from:
11.1
Keeping a pet shop?
Yes/No
11.2
Keeping a dog?
Yes/No
11.3
Keeping an animal boarding establishment?
Yes/No
11.4
Keeping a riding establishment?
Yes/No
11.5
Having custody of animals?
Yes/No
11.6
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
11.7
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
11.8
If ‘yes’ to any of these questions, please provide details
12
Additional details
Please check local guidance notes and conditions for any additional information which may be required
12
.1
A
dditional information which is required or may be
relevant to the application
Standard payment and declaration section
13
Payment
13.1
Payment must be made at the time of making the application
13.2
Confirm date payment of fee made and
how made e.g. online. Include reference
number
14
Statutory guidance
All applicants to tick that they have read the applicable statutory guidance and conditions
14.1
Selling Animals as Pets
14.2
Boarding for Cats
14.3
Boarding in Kennels for Dogs
14.4
Day Care for Dogs
14.5
Home Boarding for Dogs
14.3
Keeping or Training Animals for
Exhibition
Page 5 of 6
14
Statutory guidance
14.4
Hiring Out Horses
14.5
Breeding Dogs
15
Additional information
Please attach the following Information - ALL INFORMATION IS REQUIRED
15.1
A Basic DBS (Dated within 3 months of
the application date)
15.2
Right to Work (Passport, Birth
Certificate, ID Card or Home Office
Document)
15.3
Proof of Planning Permission
(including GBC Reference number)
15.4
A plan of the premises
15.5
Insurance policy (minimum £5million)
15.6
Standard operating procedures
15.7
Emergency response plan
15.8
Infection control procedure
15.9
Qualifications
15.10
Training records
15.11
Other documents may be required
specific to the type of activity
16
Declaration
16.1
This section must be completed by the applicant. If you are an agent, please ensure this section is completed
by the applicant.
16.2
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 dog breeding at 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.
16.3
Ticking this box indicates you have read
and understood the above declaration
16.4
Full name
16.5
Capacity/position of signatory
16.6
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
click to sign
signature
click to edit
Page 6 of 6
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 Breeding Dogs Application Form Dog breeding licence application form - Eastbourne Borough Council

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Completed 7 July 2020

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