Fillable Standard applicant profile section 1 (Breckland District Council)

Fill Online, Printable, Fillable, Blank Standard applicant profile section 1 (Breckland District Council) Form

Use Fill to complete blank online BRECKLAND DISTRICT COUNCIL pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Standard applicant profile section 1 (Breckland District Council)

On average this form takes 78 minutes to complete

The Standard applicant profile section 1 (Breckland District Council) form is 17 pages long and contains:

  • 1 signature
  • 12 check-boxes
  • 304 other fields

Country of origin: UK
File type: PDF

Use our library of forms to quickly fill and sign your Breckland District Council forms online.

BROWSE BRECKLAND DISTRICT COUNCIL FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Standard applicant profile section 1
1 Reference number
1.1 System reference Number (if known)
1.2 Your reference (if known)
Please complete all the questions in the form.
If you have nothing to record, please state "Not applicable" or "None"
2a Agent
2.1
Are you an agent acting on behalf of the
applicant
Yes No
If no, go to 3.1
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 Date of birth:
3.5 Main telephone number
3.6 Other telephone number
3 Applicant details
3.7
Are you applying as a business or
organisation, including a sole trader
Yes No
3.8 Are you applying as an individual Yes No
4a 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, explain?
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 – 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
Page 1 of 7
The Animal Welfare (Licensing of Activities Involving Animals) (England)
Regulations 2018
Application for a licence to hire out horses
Please complete all the questions in the form.
If you have nothing to record, please state "Not applicable" or "None"
1 Type of Application
1.1 Type of Application New Renewal
If new, go to 1.3
1.2 Existing licence number
Further information about the business
1.3 Please give details of the types of activity
2 Establishment to be licensed
2.1 Name of premises/trading name
2.2 Address of premises
2.3 Telephone number
2.4 Email address
2.5 Is the establishment open throughout the
year?
Yes No
2.6 When is it normally open?
2.7 Do you have planning permission for this
business use? When was this granted?
Yes No Granted
3 Accommodation and facilities
Please describe the accommodation available for horses:
3.1 Stalls (please give the number)
3.2 Boxes (please give the number)
3.3 Covered yard (please give dimensions)
3.4 Open yard (please give dimensions)
Please describe the land available for:
3.5 Grazing
3.6 Instructing or demonstrating
3.7 Exercise
Page 2 of 7
Please describe the accommodation available for:
3.8 Forage and bedding
3.9 Equipment and saddlery
Please describe the arrangements in place for:
3.10 Water supply and watering horses
3.11 Disposal of animal waste
3.12
Protection of horses in event of a fire, and
fire precautions
4a Horses
4.1
How many horses are kept under the
terms of the Act at the present time?
4.2
How many horses is it intended to keep
under the terms of the Act during the
year?
Please provide details of all the horses currently kept at Schedule 1 of this form.
5 Management of the establishment
5.1
Name & Address of the manager/person with direct control of the
establishment
5.2 Does the manager have any of the following certificates? (tick all that apply)
Assistant Instructor’s Certificate of the British Horse Society
Intermediate Instructor’s Certificate of the British Horse Society
Instructor’s Certificate of the British Horse Society
Fellowship of the British Horse Society
Fellowship of the Institute of the Horse
Other, please provide information
5.3
Please give details of the manager’s experience in the
management of horses
5.4 Does a responsible person live at the establishment?
Yes No
Page 3 of 7
5.5 What are the arrangements in the event of an emergency?
5.6
Will a person who is under 16 years of age be left in charge of the
establishment at any time?
Yes No
5.7
Will a responsible person (of 18 years or over) provide supervision
at all times while horses from the establishment are used for riding
instruction or are hired out for riding (except in the case of the
hirer being competent to ride without supervision)?
Yes No
6 Veterinary surgeon
6.1 Name of usual veterinary surgeon
6.2 Company name
6.3 Address
6.4 Telephone number
6.5 Email address
7 Public liability insurance
7.1 Do you have public liability insurance?
Yes No
If no, go to 7.10
7.2
Please provide details of the policy
7.3 Insurance company
7.4 Policy number
7.5 Period of cover
7.6 Amount of cover (£)
Page 4 of 7
Does this policy:
7.7
Insure against liability for any injury sustained by those who hire a horse
from you for riding and those who use a horse in the course of receiving
instruction in riding, provided by you in return for payment?
Yes No
If yes
to all,
go to
8.1
7.8 Insure against liability arising out of such hire or use of a horse?
Yes No
7.9
Insure such hirers or users in respect of any liability which may be incurred
by them in respect of injury to any person caused by, or arising from, such
hire or use?
Yes No
7.10
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,
Page 5 of 7
9 Additional details
Please check local guidance notes and conditions for any additional information which may be required
9.1
Additional information which is
required or may be relevant to
the application
Page 6 of 7
Schedule 1 – Horse Details
Name of horse Description including size Sex Age Horse
passport
number
Purpose for which horse is
kept
Age range of
people who
ride this
horse
Horse 1
Horse 2
Horse 3
Horse 4
Horse 5
Horse 6
Horse 7
Horse 8
Horse 9
Horse 10
Horse 11
Horse 12
Horse 13
Page 7 of 7
Name of horse Description including size Sex Age Horse
passport
number
Purpose for which horse is
kept
Age range of
people who
ride this
horse
Horse 14
Horse 15
Horse 16
Horse 17
Horse 18
Horse 19
Horse 20
Horse 21
Horse 22
Horse 23
Horse 24
Horse 25
Horse 26
Horse 27
Standard declaration section
1 Model Licence Conditions & Guidance
All applicants to tick that they have read the applicable model licence conditions and guidance
1.1 Selling animals as pets
1.2
Providing or arranging boarding for cats
or dogs
1.3 Exhibition of animals
1.4 Hiring out horses
1.5 Breeding dogs
2 Additional Information
Please attach the following Information and tick once completed:
2.1 A plan of the premises
2.2 Insurance policy
2.3
Written operating procedures to include
emergency plan, staff training policy
2.4 Risk Assessments (including Fire)
2.5
Management of the following – feeding,
cleaning, transportation, disease control,
health and welfare, death or escape
2.6 Qualifications
2.7 Training/experience records
3 Declaration
3.1
This section must be completed by the applicant. If you are an agent please ensure this section is completed
by the applicant.
3.2
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. It is an
offence to give false information.
3.3
Signing this box indicates you have read
and understood the above declaration
Signature:
3.4 Full Name
3.5 Capacity
3.6 Date
Notes – Persons who may not apply for a licence
1. A person who has at any time held a licence which was revoked under regulation 15 of these
Regulations.
2. A person who has at any time held a licence which was revoked under regulation 17 of the Animal
Welfare (Breeding of Dogs) (Wales) Regulations 2014(a).
3. A person who has at any time held a licence which was revoked under regulation 13 of the Welfare of
Wild Animals in Travelling Circuses (England) Regulations 2012(b).
4. A person who is disqualified under section 33 of the Welfare of Animals Act (Northern Ireland) 2011(c).
5. A person who has at any time held a licence which was revoked under regulation 12 of the Welfare of
Racing Greyhounds Regulations 2010(d).
6. A person who is disqualified under section 34 of the Act.
7. A person who is disqualified under section 40(1) and (2) of the Animal Health and Welfare (Scotland)
Act 2006(e).
8. A person who is disqualified under section 4(1) of the Dangerous Dogs Act 1991(a).
9. A person who is disqualified under Article 33A of the Dogs (Northern Ireland) Order 1983(b).
10. A person who is disqualified under section 6(2) of the Dangerous Wild Animals Act 1976(c) from
keeping a dangerous wild animal.
11. A person who is disqualified under section 3(3) of the Breeding of Dogs Act 1973(d) from keeping a
breeding establishment for dogs.
12. A person who is disqualified under section 4(3) of the Riding Establishments Act 1964(e) from keeping a
riding establishment.
13. A person who is disqualified under section 3(3) of the Animal Boarding Establishments Act 1963(f) from
keeping a boarding establishment for animals.
14. A person who is disqualified under section 5(3) of the Pet Animals Act 1951(g) from keeping a pet shop.
15. A person who is disqualified under section 1(1) of the Protection of Animals (Amendment) Act 1954(h)
from having custody of an animal.
16. A person who is disqualified under section 4(2) of the Performing Animals (Regulation) Act 1925(i).
17. A person who is disqualified under section 3 of the Protection of Animals Act 1911(j) from the ownership
of an animal.
How to pay
Breckland Council, Elizabeth House, Walpole Loke, Dereham, Norfolk, NR19 1EE
By paying by debit card or credit card we can process your application more quickly.
To pay by card please complete and return this form to:
Licensing Payment, Breckland Council, Elizabeth House, Walpole Loke, Dereham, Norfolk, NR19 1EE
This form will be destroyed once the card has been debited.
Debit/Credit card details
Licence number (if known): ...........................................................................................................
Applicant’s name: ...........................................................................................................
Applicant’s address: ...........................................................................................................
...........................................................................................................
Postcode: ..................................................................................
Cardholder’s name: ...........................................................................................................
Cardholder’s telephone number: ...........................................................................................................
Cardholder’s email address: ...........................................................................................................
Cardholder’s address: ...........................................................................................................
...........................................................................................................
Postcode: ..................................................................................
Amount to debit: £………………………………
Card number:
Valid from /
Expires end /
Security number
Card issue number* What is the Security Number?
*Maestro/Cirrus only
Cardholder’s signature: ................................................... Date: ............................................
Other methods of payment
Cheques made payable to Breckland Council
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Standard applicant profile section 1 (Breckland District Council)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 9 February 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document