2015/16 Response Services Cat Registration Application Animal Management (Cats and Dogs) Act 2008 1. Applicant details Please note that the registered owner/s of the animal/s must be 18 years of age or older Surname Given names Date of birth Postal address Suburb State Business phone Postcode A/H phone Mobile Email address Fax Pension Card No.: (if a pensioner) 2. Property Address details (where animal will be kept) Property Address Property no. Suburb State Postcode Transferred from another Council? Please name Council and current registration number: 3. Animal details 1 Cat name Breed Colour Age Sex Male Female Desexed Yes, complete vet details No Vet name __________________________________________________________________________________ Phone number ______________________________________________________________________________ Address ___________________________________________________________________________________ Any other noticeable, distinguishing features or marks: Microchip number: Microchip supplier: 4. Animal details 2 Cat name Breed Colour Age Sex Male Female Desexed Yes, complete vet details No Vet name __________________________________________________________________________________ Phone number ______________________________________________________________________________ Address ___________________________________________________________________________________ Any other noticeable, distinguishing features or marks: Microchip number: Microchip supplier: If the number of animals you wish to register exceeds the permissible number allowed on your property, you will need to apply for a licence. Privacy Council will use any personal information provided by you for the intended purpose only and for remaining in contact with you. Council is authorised to collect this information in accordance with the Local Government Act 2009 and other Local Government Acts. Your personal information is only accessed by persons authorised to do so. Council may provide information about you to any relevant Queensland State Department. Your personal information is dealt with in accordance with council’s privacy policy. 1 of 2 2015/16 Response Services Cat Registration Application V2 03/08/15 5. Animal annual registration fees and charges Animal registration period is 1 October 2015 to 30 September 2016 Non desexed cat $128.00 Non desexed cat - owned by a pensioner $108.00 Non desexed cat - owned by a member of the Queensland Feline Association or similar state or national organisation (proof required) $68.00 Desexed cat $29.00 Desexed cat - owned by a pensioner $21.00 Desexed cat with microchip (PID) $13.00 Desexed and micro chipped (PID) cat - owned by a pensioner $0.00 Kitten - up to 6 months of age $0.00 Replacement tag $0.00 Lifetime registration (Note: This fee is a one-off registration fee with no annual renewal and is only available for desexed and microchipped cats) $75.00 Lifetime registration fee - Desexed and microchipped cat 6. Declaration of applicant I/We, the applicant, declare that the above information is correct in all respects, at the time of lodgement of this application with the Sunshine Coast Regional Council. Should any of the details given in relation to this application be changed in the future, the applicant shall advise the Sunshine Coast Regional Council in writing prior to any such change being implemented. Signature Date Signature Date OFFICE USE ONLY Animal no. 1 Amount paid Date paid Receipt no. Initial Date stamp Tag no. Animal no. 2 Tag no. Payment options In person Customer service centres: 8.30 am to 4.30 pm Monday to Friday (excludes public holidays). By mail Cheque or money order to be made payable to: Sunshine Coast Regional Council. Cheque 2 of 2 Money order Mastercard Visa Card number Expiry date Amount $ Name on card Signature of cardholder Phone Is a receipt required? 2015/16 Response Services Cat Registration Application V2 03/08/15 Yes No