Conservation and Land Management Regulations 2002
Wildlife Conservation Act 1950
Regulation 16 (Display)
Application to acquire new fauna for existing Regulation
16 licence holders
Application for approval from Department of Parks and Wildlife for existing Regulation 16 licensee to acquire
fauna to add to licence to display.
PLEASE ALLOW TWENTY (20) WORKING DAYS TO PROCESS COMPLETE AND CORRECT APPLICATIONS.
WHERE NO UP-TO-DATE RETURN(S) HAS BEEN RECEIVED FOR CURRENTLY LICENSED ANIMALS THIS
APPLICATION TO ACQUIRE ADDITIONAL FAUNA FOR DISPLAY CANNOT PROGRESS UNTIL RETURN(S)
ARE RECEIVED.
PLEASE PRINT CLEARLY IN ALL SECTIONS.
Completed forms must be returned to:
Department of Parks and Wildlife
Locked Bag 30 Bentley Delivery Centre WA 6983
Or faxed to (08) 9219 8242 or emailed.
Further information on the licensing requirements
is available from DPaW Wildlife Licensing Section
Phone: (08) 9219 9831
Email: wildlifelicensing@dpaw.wa.gov.au
Licensee
Surname
Other names
Dr/Mr/Mrs/Miss/Ms
Reg. 16 Licence #
Date of expiry
Telephone #:
Mobile #:
Signature
Date
Where not previously supplied to DPaW the applicant is to provide the following:
1
2
proof of identity and age (driver’s licence, passport, or other appropriate document)
details of any relevant convictions in Australia in the past five (5) years. Relevant conviction means a
wildlife related offence
For the species being applied for:
3
4
5
a written plan detailing educational program
enclosure details
welfare and husbandry details
Please indicate date if this information has been provided before
Date ………/…….…/……
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Application for approval to acquire new fauna for existing Regulation 16 Licence to Display
Please complete one (1) sheet per species that you wish to add to your existing Regulation 16
Licence to Display
SPECIES:
Common Name:
No. to be acquired:
Scientific Name:
____M
____F
____Un
No. of this species
already held:
Supplier’s Name:
Supplier’s Lic. #:
Is fauna property of the Crown?
Y / N
If Y was this obtained through seizure or dereliction?
Seizure
Is this a replacement animal?
Y / N
____M
____F
____Un
If yes, attach details
Derelict
If yes, attach details
ACQUISITION:
Reason for acquisition:
Acquiring from licensee
Licence #
Approved education program for this species
provided to DPaW previously?
Y / N
If no, please attach details
ENCLOSURES:
Y / N
Fauna to be housed in enclosures previously
Please attach details including schematics and / or
approved by DPaW?
photographs of enclosures to be used
Fixed on-site only
Fixed on-site and mobile
Mobile only
WELFARE/HUSBANDRY:
Name of veterinarian to provide
species specific care:
Address:
Have husbandry details previously been approved by
DPaW for this species?
Contact No.:
Y / N
If no, please attach details
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