Fillable Application for a licence to sell animals (Harlow District Council)

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Application for a licence to sell animals (Harlow District Council)

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Page 1 of 6
The Animal Welfare (Licensing of Activities Involving Animals) Regulations 2018
Application for a licence to sell animals
Please complete all the questions in the form.
If you have nothing to record, please put "n/a" or "none"
Applicant Profile Section
1
Reference number
1.1
System reference number
1.2
Your reference
1.2a
Agent
1.2.1
Are you an agent acting on behalf of
the applicant?
Yes No If no go to 1.3
1.2b
Further information about the agent
1.2.2
Name
1.2.3
Address
1.2.4
Email
1.2.5
Main telephone number
1.2.6
Other telephone number
1.3
Applicant details
1.3.1
Name
1.3.2
Address
1.3.3
Email
1.3.4
Main telephone number
1.3.5
Other telephone number
1.3.6
Applying as a business or
organisation, including a sole trader
Yes No
1.3.7
Applying as an individual
Yes
No
1.4a
Applicant business
1.4.1
Is your company registered with
companies house?
Yes
No
1.4.2
Registration number
1.4.3
Is your business registered outside the
UK?
1.4.4 VAT number
1.4.5 Legal status of the business
Page 2 of 6
1.4a
Applicant business
1.4.6 Your position in the business
1.4.7
The country where your head office is
located
1.4.7b
Business address – this should be your official address – the address required of you by law to
receive all communication
1.4.8
Building name or number
1.4.9
Street
1.4.10
District
1.4.11
City or town
1.4.12
County or administrative area
1.4.13
Post code
1.4.14
Country
Type of Business Section
2
Type of business
2.1 Pet shop
2.2
Home sales
2.3 Internet sales
2.4 Wholesales
2.5
Third party sales
2.6 Hobby sales (pet fairs)
2.7
Sale of animals to the public as pets by
means of a fixed or minimum donation
2.8 Other (please state)
3
Type of application
3.1
Type of application
New
Renewal
3.2 Existing licence number
3b
Further details about the applicant
3.3
Do you have any training certificates or
qualifications?
Yes
No
If no, go to 3.5
3.4
Please provide details of training
certificates and qualifications
3.5
Please provide details of relevant
experience
3.6
Date of birth
4
Premises to be licensed
4.1
Name of premises/trading name
4.2
Address of premises
4.3 Telephone number of premises
4.4
Email address
4.5
Do you have planning permission for
this business use?
Yes
No
Page 3 of 6
5
Accommodation and facilities
5.1 Number and size of rooms to be used
5.2 Heating arrangements
5.3 Method of ventilation of premises
5.4
Lighting arrangements (natural and
artificial)
5.5 Water supply
5.6 Facilities for food storage and preparation
5.7
Arrangements for disposal of excreta,
bedding and other waste material
5.8
Isolation facilities for the control of
infectious diseases
5.9
Fire precautions/equipment and
arrangements in the case of fire
5.10
Do you keep and maintain a register of
animals?
Yes
No
5.11 When the premises are closed what
arrangements are in place to ensure the
welfare of animals?
6
Animals to be sold
Please provide details of the animals to be sold
Type
Yes
Maximum
number
Details of
accommodation
including size
Age at which to
be sold
6.1 Dogs / puppies
6.2 Cats /kittens
6.3 Chipmunks
6.4 Rabbits and cavies
6.5 Hamsters
6.6 Rats, mice and gerbils
6.7
Larger domesticated mammals, e.g.
goats, pot-bellied pigs
6.8
Primates e.g. marmosets
6.9
Parrots, parakeets and macaws
6.10
Pigeons
6.11
Other large birds
(please specify)
6.12
Budgerigars, finches and other small
birds
6.13
Tortoises
6.14
Snakes and lizards
6.15
Tropical fish
6.16
Marine fish
6.17
Cold water fish
6.18
Any other species
(please specify)
Page 4 of 6
7
Veterinary surgeon
7.1 Name of usual veterinary surgeon
7.2 Company name
7.3 Address
7.4 Telephone number
7.5 Email address
8a
Emergency key holder 1
8.1
Do you have an emergency key holder?
Yes
No
If no, go to 9.1
8.2
Name
8.3
Position/job title
8.4
Address
8.5 Daytime telephone number
8.6 Evening/other telephone number
8.7
Email address
8.8 Add another person? Yes No If no, go to 9.1
8b
Emergency key holder 2
8.9
Name
8.10
Position/job title
8.11
Address
8.12
Daytime telephone number
8.13 Evening/other telephone number
8.14 Email address
9
Public liability insurance
9.1 Do you have public liability insurance? Yes No If no, go to question 7.6
If yes, please provide details of the policy
9.2 Insurance company
9.3 Policy number
9.4 Period of cover
9.5 Amount of cover (£m)
9.6
Please state what steps you are taking to
obtain such insurance
10
Disqualifications and convictions
Has the applicant, or any person who will have control or management of the establishment, ever been
disqualified from:
10.1
Keeping a pet shop?
Yes
No
10.2
Keeping a dog?
Yes
No
10.3
Keeping an animal boarding establishment?
Yes
No
10.4
Keeping a riding establishment?
Yes
No
10.5
Having custody of animals?
Yes
No
10.6
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
Page 5 of 6
10
Disqualifications and convictions
10.7
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
10.8
If yes to any of these questions, please provide details
11
Additional details
Please check local guidance notes and conditions for any additional information which may be required
11.1
Additional information which is required or may be
relevant to the application
Payment and Declaration Section
12
Payment
12.1
Payment must be made at the time of making the application
12.2
Please see website page for the relevant fees
13
Model licence conditions and guidance
All applicants to tick that they have read the applicable model licence conditions and guidance
13.1
Selling pets
13.2
Animal boarding
13.3
Performing animals
13.4
Riding establishments
13.5
Dog breeding
14
Additional information
Please attach the following information
14.1
A plan of the premises
14.2
Insurance policy
14.3
Operating procedures
14.4
Risk assessments (including fire)
14.5
Infection control procedure
14.6
Qualifications
14.7
Training records
15
Declaration
15.1
This section must be completed by the applicant. If you are an agent please ensure this section is completed
by the applicant.
15.2
I am aware of the provisions of the relevant Act and model licence conditions. The details contained in the
application form and any attached documentation are correct to the best of my knowledge and belief.
15.3
Ticking this box indicates you have read
and understood the above declaration
15.4
Full name
15.5
Capacity
15.6
Date
Page 6 of 6
Please return this application form to:
Environmental Health Services
Harlow Council
Civic Centre
The Water Gardens
Harlow
Essex CM20 1WG
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Application for a licence to sell animals (Harlow District Council)

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Completed 1 August 2020

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