S:\ADMINISTRATION\TEAM 4\MASTERS\ANIMALS - DANG.WILD APP. NEW.DOC
FALKIRK COUNCIL
Development Services
DANGEROUS WILD ANIMALS ACT 1976
Application for Licence to Keep Dangerous Wild Animal(s)
To the
(1)
Names of Applicant: ……………………………………………………………………………………………
Date of Birth: …………………………………………………………………………………………………….
Address: ………………………………………………………………………………………………………….
………………………………………………………………………….. Tel. No.: ……………………………..
Address of Premises where animal(s) is/are to be kept: …………………………………………………….
……………………………………………………………………………………………………………………….
Species of Animal(s) to be kept:
(2)
……………………………………………………………………………..
……………………………………………………………………………………………………………………….
Numbers to be kept: ………………….. Male ………………… Female ……………. Total
Is it intended to breed or attempt to breed from these animals? YES/NO
Description and dimensions of accommodation to be used: ……………………………………………
………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………….
Description of type of food to be supplied and source: ………………………………………………….
………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………….
Details of Insurance Policy held to cover liability for damage caused by animal(s):
(3)
Company ……………………………………………………………………………………………………..
Policy No. …………………………….. Expiry Date …………………… Amount …………………..
I HEREBY DECLARE that I am over 18 years of age and not disqualified by being convicted of any offence at any time
under the Protection of Animals Acts 1911 to 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
Act 1964 and 1970 or the Breeding of Dogs Act 1973 and 1991 and the Breeding and Sale of Dogs (Welfare) Act 1999.
I APPLY for a Licence under the Dangerous Wild Animals Act 1976 in respect of which I agree to pay the
prescribed fee.
(4)
DATED : …………………………………….. (Name)
(5)
………..…………………………..…….
(1) Insert name of local authority.
(2) Give scientific name if possible.
(3) This Policy must be produced to an inspecting officer if required.
(4) The fee is such sum as, in the authority's opinion, is sufficient to meet the direct and indirect costs which they may incur as a result of
this application.
(5) Indicate capacity, if signing on behalf of a company or partnership.
Yes
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