DANGEROUS WILD ANIMALS ACT 1976
APPLICATION FOR A LICENCE TO KEEP DANGEROUS WILD ANIMALS
What type of application is this? (Please tick box)
New
Renewal
Applicants Name(s) ________________________________________________________
Applicants Address ______________________________________________________
_______________________________________________________________________
Contact Tel No(s) Home___________________________________________________
Mobile__________________________________________________
General Information
(Please continue on additional sheets if necessary)
Species of dangerous wild animals
concerned
Number(s) of dangerous wild
animals to be kept (by Species)
I / We have read and understood the Council’s Dangerous Wild Animals
Licence conditions and agree to comply with them at all times. To the best of
my / our knowledge, the information given on this form is correct.
Signature(s)
Date
Please return this form to:The Licensing Team Environment and Regulatory Services Derby City Council
The Council House Corporation Street Derby DE1 2FS
FOR OFFICE USE ONLY
-
Receipt Number: _________________________
Officer Initials: ___________________________