ANIMAL BOARDING ESTABLISHMENTS ACT 1963
Application for a licence to keep
a boarding establishment
.....................................................................…………………………….
1. Name (BLOCK CAPITALS)
.
2. Address
..................................................................……………………………...
......................................................................…………………………..
.
3. Address of boarding establishment
(if different from 2 above)
.................................................................………………………………
......................................................................…………………………..
4. Are you disqualified from:
(a) keeping a boarding establishment for animals
(b) keeping a pet shop
(c) keeping a dog
(d) having the custody of animals
YES / NO
YES / NO
YES / NO
YES / NO
5. Please give the following information about the accommodation, which the animals will occupy:
(a) construction
.........................................................................………………………………….
(b) size of quarters
..........................................................................…………………………………
(c) number of occupants
..........................................................................…………………………………
(d) exercising facilities
..........................................................................…………………………………
I agree to permit a person authorised by the council to inspect the premises before any licence is granted.
I apply for a licence to keep a boarding establishment from [date of issue / 1st January] *
* [ Delete as appropriate. A licence may run from either from the date of issue or from 1st January next and
remains valid for the remainder of the year in which it is issued]
Signature......................................................…………………….. Date.......................................………………..
Please return this form and fee due (cheques to be made payable to Cotswold District Council) to:Environment Services, Cotswold District Council,
Council Offices, Trinity Road, Cirencester, Glos GL7 1PX
The Name and Address of the Licence holder and Boarding Establishment address provided on this
application will be transferred to a Register held at Cotswold District Council Offices, Environment.
Services.
If you do not consent to your name and address being given to the public please tick this box
All other information provided will be kept confidential subject to disclosure necessitated by any legal
proceedings.
If an inspection of the premises is required, the information provided may be passed to a Veterinary
Practitioner.
(Mrs B Patel, Data Protection Officer Tel: 01285 623000 Ext 3219)