Fillable Application For A Licence To Breed Dogs (Stockton-on-Tees Borough Council)

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Application For A Licence To Breed Dogs (Stockton-on-Tees Borough Council)

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www.stockton.gov.uk Licensing Service, Municipal Buildings, Church Road, Stockton on Tees, TS18 1LD Tel: 01642 526558
The Animal Welfare (Licensing of Activities Involving Animals) Regulations 2018
Application For A Licence To Breed Dogs
Please complete all the questions in the form.
If you have nothing to record, please state "Not applicable" or "None"
1
APPLICANT PROFILE
1A
AGENT DETAILS
1.1
Are you an agent acting on behalf of the
applicant
Yes
No
If No, go to 1B
1.2
Name
1.3
Address
1.4
Email
1.5
Main telephone number
1.6
Other telephone number
1B
APPLICANT DETAILS
1.7
Name
1.8
Address
1.9
Date of birth
1.10
Email
1.11
Main telephone number
1.12
Other telephone number
1.13
Applying as a business or
organisation, including a sole trader
Yes
No
1.14
Applying as an individual
Yes
No
1C
APPLICANT BUSINESS
1.15
Is your company registered with companies
house
Yes
No
If No, go to 1.17
1.16
Registration Number
1.17
Is your business registered outside the UK
1.18
VAT Number
1.19
Legal status of the business
1C
APPLICANT BUSINESS CONTINUED
1.20
Your position in the business
1.21
The country where your head office is
located.
1D
BUSINESS ADDRESS – THIS SHOULD BE YOUR OFFICIAL ADDRESS – THE ADDRESS
REQUIRED OF YOU BY LAW TO RECEIVE ALL COMMUNICATIONS
1.22
Building name or number
1.23
Street
1.24
District
1.25
City or Town
1.26
County or administrative area
1.27
Post Code
1.28
Country
2
TYPE OF APPLICATION
2.1
Type of Application
New
Renewal
2.2
Existing licence number
2A
ANIMALS TO BE ACCOMMODATED
2.3
Wholly
Indoors
Wholly outdoors
Combination of outdoors and indoors
2.4
Breeds of dogs concerned
2.5
Number of bitches kept
2.6
Owned by the applicant
Co-owned by the applicant
On breeding terms
2.7
Provide details of the ages of bitches
kept.
2.8
Number of studs kept
2.9
Owned by the applicant
Co- owned by the applicant
On breeding terms
2.10
Provide details of the ages of the studs
kept
3
PREMISES TO BE LICENSED
3.1
Name of premises/trading name
3.2
Address of premises
3.3
Telephone number of premises
3.4
Email address
3.5
Do you have planning permission for
this business use?
Yes / No
4
ACCOMMODATION AND FACILITIES
4.1
Details of the quarters used to
accommodate animals, including
number, size and type of construction
4.2.
Exercise facilities and arrangements
4
ACCOMMODATION AND FACILITIES CONTINUED
4.3
Heating arrangements
4.4
Method of ventilation of premises
4.5
Lighting arrangements (natural &
artificial)
4.6
Water supply
4.7
Facilities for food storage & preparation
4.8
Arrangements for disposal of excreta,
bedding and other waste material
4.9
Isolation facilities for the control of
infectious diseases
4.10
Fire precautions/equipment and
arrangements in the case of fire
4.11
Do you keep and maintain a register of
animals?
Yes / No
4.12
How do you propose to minimise
disturbance from noise?
5
VETERINARY SURGEON
5.1
Name of usual veterinary surgeon
5.2
Company name
5.3
Address
5.4
Telephone number
5.5
Email address
6
EMERGENCY KEY HOLDER
6.1
Do you have an emergency key holder?
Yes / No
If No, go to 7.1
6.2
Name
6.3
Position/job title
6.4
Address
6.5
Daytime telephone number
6.6
Evening/other telephone number
6.7
Email address
6.8
Add another person?
Yes / No
If Yes, 6.2 to 6.8 will be repeated
7
PUBLIC LIABILITY INSURANCE
7.1
Do you have public liability insurance?
Yes / No
If No, go to question 7.6
If yes, please provide details of the policy
7.2
Insurance company
7.3
Policy number
7.4
Period of cover
7
PUBLIC LIABILITY INSURANCE CONTINUED
7.5
Amount of cover (£m)
7.6
Please state what steps you are taking to
obtain such insurance
8
DISQUALIFICATIONS AND CONVICTIONS
Has the applicant, or any person who will have control or management of the establishment, ever
been disqualified from:
8.1
Keeping a pet shop?
Yes / No
8.2
Keeping a dog?
Yes / No
8.3
Keeping an animal boarding establishment?
Yes / No
8.4
Keeping a riding establishment?
Yes / No
8.5
Having custody of animals?
Yes / No
8.6
Has the applicant, or any person who will have control or
management of the establishment, been convicted of any
offences under the Animal Welfare Act 2006?
Yes / No
8.7
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
8.8
If yes to any of these questions, please provide details,
9
ADDITIONAL DETAILS
Please check the local authorities website for any additional information which may be
required
9.1
Additional information which is required or
may be relevant to the application
10
PAYMENT AND DECLARATION
10A
PAYMENT
10.1
Payment must be made at the time of application and can be made in the following way
IN PERSON
Make your payment at the Cashiers Department located within the Customer Services Centre, Stockton Central Library,
Church Road, Stockton-On-Tees. Please ensure that you quote the name of your premise when making payment and
then produce your receipt and application form to a member of the Customer Services Team.
BY PHONE 01642 526558
Make your payment using your debit or credit card. Please ensure that you quote the name of your premise and type of
application when making your payment.
BY BACS TRANSFER
Please email either licensing.administration@stockton.gov.uk or banking.income@xentrall.org.uk to advise the date of
payment and amount to be paid. Please ensure that you quote the name of your premise and type of application with
your BACS payment/remittance advice to ensure that your record can be updated accordingly.
Account Name: Stockton-On-Tees Borough Council – General Account
Account No: 07436998 Sort Code: 55-61-00 UK IBAN No: GB51NWBK55610007436998
Bank Address: National Westminster Bank
123 High Street, Stockton-On-Tees, TS18 1AY
10B
DEFRA GUIDANCE
10.2
Please tick box to indicate that you have read the guidance in respect of in respect of the
animal activity you are applying for
10C
ADDITIONAL INFORMATION
Please attach the following Information
10.3
A plan of the premises
10.4
Insurance policy
10.5
Operating procedures
10.6
Risk Assessments (including Fire)
10.7
Infection control procedure
10.8
Qualifications
10.9
Training records
10D
DECLARATION
This section must be completed by the applicant. If you are an agent please ensure this
section is completed by the applicant.
10.10
I am aware of the provisions of the relevant regulations and guidance documents. Conditions
The details contained in the application form and any attached documentation are correct to the
best of my knowledge and belief.
10.11
Ticking this box indicates you have read and understood the above declaration
10.12
Full Name
10.13
Capacity
10.14
Date
HOW WE COLLECT AND USE INFORMATION
The information collected, on this form and from supporting evidence, by Stockton-on-Tees Borough Council will be used to process
your application. The information may be passed to the Department of Social Security, Employment Service and Inland Revenue and
such other Departments of the Council and external organisations but only if the law permits us to do so.
We may check information provided by you, or information about you provided by a third party, with other information held by us. We
may also get information from certain third parties, or give information to them to check the accuracy of information, to prevent or
detect crime, or to protect public funds in other ways, as permitted by law. These third parties include Government Departments and
local authorities. Stockton-on-Tees Borough Council is the Data Controller for the purposes of the Data Protection Act 1998. If you
want to know more about what information we have about you, or the way we use your information, please contact us at the address
overleaf.
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Application For A Licence To Breed Dogs (Stockton-on-Tees Borough Council)

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Completed 4 December 2020

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