Licensing Authority

Mid Devon District Council

Phoenix House, Phoenix Lane

Tiverton, Devon, EX16 6PP

Tel: 01884 244617/8/9

 

 

 

DANGEROUS WILD ANIMALS ACT 1976

 

 

Application for licence to keep

Dangerous Wild Animal(s)

 

 

 

 

 

 

 

 

 

 

 

FOR OFFICE USE ONLY

 

Date copied to Vet/EHO:

Fee: £95.00
 

Date of Inspection:

Licence No:

Received:

 

Recommendation:

Issued:

 

 


 

Please complete in block capitals or type.  In all cases ensure that your answers are inside the boxes and written or typed in black ink. Use additional sheets if necessary.  You may wish to keep a copy of the completed form for your records.

 

1. YOUR PERSONAL DETAILS

FIRST APPLICANT

TITLE  Mr Mrs Miss Ms Other (please state)

Surname

  

Forenames

I am 18 years old or over. Please tick b

Yes

No 

 

ADDRESS WHERE ORDINARILY RESIDENT

 

Post town

 

Post code

 

TELEPHONE NUMBERS

Daytime

Evening

Mobile



FAX NUMBER  

E-MAIL ADDRESS

SECOND APPLICANT (if applicable)

TITLE  Mr Mrs Miss Ms Other (please state)

Surname

  

 

Forenames

I am 18 years old or over. Please tick b

Yes

No 

 

ADDRESS WHERE ORDINARILY RESIDENT

 

Post town

 

Post code

 

TELEPHONE NUMBERS

Daytime

Evening

Mobile



FAX NUMBER  

E-MAIL ADDRESS

Payment Method On-Line                            By Cheque 

 

 

 

2. PREMISES PARTICULARS

                                                                                                                        

Name and address of premises

Post Code

Telephone No

 

a)  Species of animal(s) to be kept  (give specific name(s) if possible).

 

Total number to be kept:

Number of males:

Number of females:

 

b)  Is it intended to breed or attempt to breed from these animals?

 

 

c)  Are you the holder of a current insurance policy which insures you against liability for any damage which may be caused by the animal(s) listed above?

 

 

d)  If ‘YES’ to previous question  send evidence that you have such insurance to Licencing Section, Mid Devon District Council Phoenix House Phoenix Lane Tiverton EX16 6PP  quoting ref ; 35832112718

 

if ‘NO’ state what steps you are taking to obtain such insurance.

 

 

e)  Description and dimensions of accommodation to be used.

 

 

 

f)  Please describe the drainage facilities.

 

 

g)  What arrrangements are there for adequate ventilation?

 

 

h)  Are arrangements in place to ensure proper for temperature control?

 

 

 

i)  Please give details of type of food to be supplied, its storage and source.

 

 

j)  Are arrangements in place to ensure the animal(s) receives adequate exercise.

 

 

k)  Please describe what arrangements will be in place for ensuring veterinary care, including preventative measures.

 

l)  Please describe your action plan in the event of fire or other emergency.

 

 

 

 

I/WE HEREBY DECLARE that I/we am/are over 18 years of age and not disqualified by being convicted of any offence at any time under the Dangerous Wild Animals Act 1976; the Protection of Animals Act 1911; the Pet Animals Act 1951; Animal Boarding Establishments Act 1963; the Riding Establishments Acts 1964 and 1970; or the Breeding of Dogs Act 1973; or the Animal Welfare Act 2006 under sections 4, 5, 6 (1) & (2), 7 to 9 and 11.

 

I/WE HEREBY APPLY for a licence to keep dangerous wild animals and enclose the appropriate licence fee and a current certificate of insurance.

 

I/WE DO HEREBY CERTIFY that to the best of my/our knowledge and belief, the particulars contained in this application are correct and true.  

 

 

Signed (1st Applicant)           Date:

 

Capacity if applicant(s) sign on behalf of a Company or Partnership

 

Signed (2nd Applicant)          Dated

 

Capacity if applicant(s) sign on behalf of a Company or Partnership .

 

Human Check:

 

 

THIS APPLICATION MUST BE ACCOMPANIED BY THE APPROPRIATE FEE

 

 

 

This Authority is under a duty to protect the public funds it administers, and to this end may use the information you have provided on this form for the prevention and detection of fraud.  It may also share this information with other bodies responsible for auditing or administering public funds for these purposes.  For further information, see www.middevon.gov.uk/index.aspx?articleid=3746 or contact the Information Management and e-gov Officer on 01884 234916.