Wildlife Conservation Act 1950
Regulation 15 (TF)
Application for a licence to take fauna for education or public
purposes (fauna relocation and/or education)
Licence covers the take of fauna for relocation purposes (public) or for education purposes.
Completed forms should 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 9833
Email: wildlifelicensing@dpaw.wa.gov.au
IMPORTANT INFORMATION FOR APPLICANTS
Please allow twenty (20) working days to process complete and correct applications.
Only complete and correct application forms will be processed. Incomplete application forms will be
returned unprocessed to the applicant for correction. Please print clearly in all sections.
No fees apply to this permit type at the present time but this may be the subject of review in the future.
Please be familiar with the requirements of the relevant legislation before applying for a Regulation 15 licence issued
under the provisions of Wildlife Conservation Act 1950 - available via the State Law Publisher, www.slp.wa.gov.au.
1 Applicant’s name and date of birth
Surname
Dr/Mr/Mrs/Miss/Ms
Other names
Address (residential)
Postcode
Address (postal)
Postcode
Phone
Fax
Mobile
Email
Date of birth
Applicant is required to provide:
1. proof of identity and age (driver’s licence, passport, or other appropriate document).
2. details of any relevant convictions in Australia in the past five (5) years. Relevant conviction means a wildlife
related offence.
Signature of applicant
………………………………………
Date
………/…….…/……
DPaW OFFICE USE ONLY
APPROVAL
Application is / is not approved.
Date:
Signature
Position held:
Licence # issued _ _ _ _ _ _ _ _ _ _
Licensing Officer:
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Licence to take fauna for educational or public purposes
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Licence to take fauna for educational or public purposes
The information requested will enable your application to be assessed and processed in a timely manner. Please read and
answer ALL sections. If any requested information is unknown or not applicable, please indicate this in the relevant box or
mark N/A rather than leaving it blank. Incomplete applications forms may result in delays in assessment, or rejection of the
application. * indicates sections that MUST be completed.
If there insufficient space on this form for you to provide the complete information to support your application, please provide
on attached pages.
2 Purpose for requesting licence *
Education
Fauna relocation
Other (Please specify):
3 Project details *
Species
TO WHAT SPECIES DOES THIS APPLICATION APPLY? LICENCES ARE NOT NORMALLY ISSUED TO COLLECT THREATENED SPECIES.
IF APPLYING TO TAKE THREATENED SPECIES, PLEASE PROVIDE JUSTIFICATION BELOW.
COMMON NAME
SCIENTIFIC NAME
QUANTITY
Background
PROVIDE CONTEXT AND REASONS FOR REQUESTING THE LICENCE. THIS MAY INVOLVE OUTLINING THE HISTORY OF A SITUATION
AND HOW IT HAS ARISEN.
Duration of the field component of the project *
PROVIDE THE DATES THAT YOU INTEND TO BE IN THE NOMINATED AREA (AS DESCRIBED IN SECTION 4 “LOCATION OF PROJECT”).
START DATE*
END DATE*
Methods/Procedures *
DESCRIBE THE TECHNIQUES AND EQUIPMENT TO BE USED FOR TAKING FAUNA, INCLUDING MEANS OF MAINTAINING THE
WELFARE OF THE FAUNA. PLEASE SPECIFY DETAILS OF THE TYPE AND NUMBER OF TRAPS IN THE NEXT SECTION.
Anticipated outcomes and conservation / management benefits
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Licence to take fauna for educational or public purposes
Traps *
IF USING TRAPS, SHOW TYPE, SIZE AND NUMBER TO BE SET E.G. 20 X 5 SITES
LARGE CAGE TRAPS
DRY PIT TRAPS
SMALL CAGE TRAPS
WET PIT TRAPS
ELLIOTT TRAPS
OTHER TRAPS (SPECIFY)
OTHER TECHNIQUES
(SPECIFY)
HYGIENE PROTOCOLS USED (DETAIL CLEANING
METHODS AND DURATION)
4 Location of project (capture and release sites) *
DESCRIBE WHERE THE PROJECT IS TO BE UNDERTAKEN. IF POSSIBLE, ATTACH MAPS SHOWING LOCATIONS OF PROPOSED
COLLECTING SITES. IF UNDERTAKING A FAUNA RELOCATION PROVIDE DETAILS OF BOTH COLLECTING AND RELEASE SITES.
NOTE: LICENCES ARE NOT NORMALLY ISSUED TO COLLECT IN CONSERVATION RESERVES. APPLICATIONS TO COLLECT IN
CONSERVATION RESERVES MUST BE SUPPORTED BY FULL REASONS AND A SEPARATE REGULATION 4 APPLICATION FORM
MUST BE COMPLETED.
5 Permission *
Written permission of the landowner / occupier of the collection site attached
For relocation purposes:Written permission of the landowner / occupier of the release site attached
6 Experience of personnel
Relevant experience and qualifications of applicant
PROVIDE DETAILS OF RELEVANT EXPERIENCE AND QUALIFICATIONS OF THE APPLICANT.
Referees
NAMES AND FULL CONTACT DETAILS OF TWO REFEREES WHO HAVE BEEN CONTACTED BY THE APPLICANT AND WHO CAN
ATTEST TO THE APPLICANT’S CONTRIBUTION TO AND EXPERTISE IN THE FIELD OF THE PROJECT.
REFEREE 1
REFEREE 2
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Additional personnel
Will collecting be done by personnel IN ADDITION TO THE APPLICANT?
NAME
RESIDENTIAL ADDRESS
Yes
No
QUALIFICATIONS
7 Ethical considerations
Means, facilities and place of temporarily holding fauna *
SPECIFY DETAILS OF THE FACILITY WHERE THE FAUNA ARE TO BE HELD.
Transport method for fauna *
INDICATE WHETHER HARD OR SOFT CONTAINMENT METHODS (EG PET PACK, CALICO BAGS) WILL BE USED TO CONTAIN ANIMALS
FOR TRANSPORT. PROVIDE INFORMATION ON MODE OF TRANSPORT (EG CAR, BOAT AEROPLANE) AND OUTLINE MEASURES
TAKEN TO MAXIMISE COMFORT OF ANIMALS (EG AIRCONDITIONING).
Ultimate fate of fauna taken *
INDICATE WHETHER FAUNA (VERTEBRATE AND INVERTEBRATE) TAKEN IS TO BE RELEASED, HELD IN CAPTIVITY, EUTHANASED
OR HANDED TO ANOTHER AGENCY, SUCH AS THE WA MUSEUM. IF ANY FAUNA ARE TO BE EUTHANIZED, PROVIDE DETAILS OF
THE TECHNIQUE TO BE USED AND HOW THE DECEASED ANIMALS WILL BE DISPOSED OF.
8 Applicant’s affiliation
PRIVATE INDIVIDUAL
PRIVATE CONSULTING GROUP
OTHER (SPECIFY)
9
Declaration *
I hereby:
9.1
certify that the information provided in this application is true and correct, and
9.2
agree to comply with the provisions of the Wildlife Conservation Act and Regulations and the
Conservation and Land Management Act and Regulations and all conditions applicable to the issue of
this licence.
SIGNATURE
DATE
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