DANGEROUS WILD ANIMALS ACT 1976 APPLICATION FORM FOR GRANT OR RENEWAL OF A DANGEROUS WILD ANIMALS LICENCE PLEASE READ GUIDANCE NOTES SUPPLIED BEFORE COMPLETING FORMS A. PERSONAL DETAILS Full Name ……………………………………………………………………………………….. Home Address ……………………………………………………………………………………….. ……………………………………………………………………………………….. ……………………………………………………………………………………….. Post Code ……………………………………………………………………………………….. Tel No ……………………………………Mobile………………………………………….. Email ……………………………………………………………………………………….. Date of Birth ………………………………………Age…………………………………………… Place of Birth ……………………………………………………………………………………….. Do you intend to carry out the day to day management of the business YES / NO B. BUSINESS DETAILS Full Name of Business ………………………………………………………………………............ Address of Registered Or Principle Office ………………………………………………………………………............ ………………………………………………………………………………. ………………………………………………………………………............ Post Code ………………………Email………………………………………………… Tel No ………………………………………………………………………………. C. LICENCE DETAILS Tick one box only Grant Renewal If Renewal – Licence No. ………………………………………………………………………... If not a Renewal: Have you previously held a Dangerous Wild Animal Licence in this area or any other in the U.K.? If Yes Area: YES / NO ……………………………………………………….......... Dates and duration of licence : ……………………………………………………………... Reason no longer licensed: ……………………………………………………………... If not a Renewal: Have you previously been refused a Dangerous Wild Animal Licence in this area or any other of the U.K.? YES / NO If Yes Area: D. ……………………………………………………………... Reason for refusal: ……………………………………………………………... Date(s) of refusal: ……………………………………………………………... PREMISES DETAILS Address of accommodation where animal(s) is / are to be kept. ………………………………………………………………………………………………………………….. ………………………………………………………………………………………………………………….. ………………………………………………………..Post Code……………………………………………. Tel no………………………………………………..Email…………………………………………………........ Description and dimensions of accommodation to be used ………………………………………………………………………………………………………………….. …………………………………………………………………………………………………………………. ………………………………………………………………………………………………………………….. . E. ANIMAL DETAILS Species, sex and number of animals to be kept ………………………………………………………………………………………………………………….. ………………………………………………………………………………………………………………….. ………………………………………………………………………………………………………………….. Is it intended to breed or attempt to breed with animals? F. YES / NO KEEPER(S) DETAILS Name(s) of person(s) proposed by the applicant to act as keeper(s) of the animal(s) on his or her behalf ………………………………………………………………………………………………………………….. ………………………………………………………………………………………………………………….. ………………………………………………………………………………………………………………….. G. INSURANCE DETAILS Details of the Insurance Policy to cover liability Name of Company ………………………………………………………………………………. Address of Company ………………………………………………………………………………. ………………………………………………………………………………. ………………………………………………………………………………. Policy No…………………………Expiry Date…………………………Amount £………………………... DECLARATION I hereby declare that I am over 18 years of age and not disqualified by being convicted of any offence at any time under the Protection of Animal Act 1911 to 1964, the Protection of Animals (Scotland) Act 1912, The Protection of Animals Act 1934, the Pet Animals Act 1951, the Animal Boarding Establishments Act 1963, the Riding Establishments Act 1964 and 1970 or the Breed of Dogs Act 1973. I require the licence to operate from the ………..........day of ……………….20…………… A remittance of £…………………….is enclosed for the licensing fee. Signature of applicant Dated ………………………………………………………………………………. ………………………………………………………………………………. Data Protection Act 1998 privacy notice – Personal information of any kind, including sensitive information like convictions, supplied by applicants on a licence application form or associated documents may be stored on a computer and/or paper file system by the authority (Moray Council and/or Moray Licensing Board) as part of the licensing process. Wherever possible the authority will take steps to preserve privacy e.g. by the use of case reference numbers rather than names. Information may be shared with and received from: Other council departments; other councils/authorities; government departments; the police; the fire and rescue service; and other relevant parties e.g. community councils or courts. Information may be shared by: any method. Public-sector organisations can share data privately and securely by sending emails via the UK Government Connect Secure Extranet (GCSX). In addition they can communicate with other authorities Europe wide via the EC’s secure Internal market Information (IMI) system. Information may be used for: Vetting and background enquiries; regulatory functions; enforcement; protection of public funds; auditing; detection and prevention of crime (including data matching exercises for this purpose); and promoting equalities. Information may be made available to the public for the purposes of: public consultation; to advertise applications; through public licensing meetings; and to populate public registers. Applicant’s Consent: By signing the form the applicant consents to the Council / Licensing Board processing information in these ways. Data Protection Rights: Individuals have the rights to: ask what the Council uses the information for; be provided with a copy of the information; be given details of the purposes for which the Council uses the information; know about persons/organisations to whom the information is disclosed; ask for incorrect data to be corrected. GUIDANCE NOTES The Application Form The application form is split into 7 sections A. B. C. D. E. F. G. Personal Details Business Details Licence Details Premises Details Animal Details Keeper(s) Details Insurance Details You must answer all of the questions as fully as you can as failure to do so may result in your application being returned to you. Your application will not be processed until you have provided all the necessary information. A. PERSONAL DETAILS You require to complete this section if you are an individual person applying for a Dangerous Wild Animals Licence. It is essential that your full details are supplied on the application form so that necessary Police checks can be undertaken swiftly and so your application can be progressed as quickly as possible. B. BUSINESS DETAILS You require to complete this section if the premises is run by a company or partnership rather than an individual person. C. LICENCE DETAILS A Dangerous Wild Animal Licence generally lasts for a maximum of 1 year although the Licensing Authority have the discretion to grant it for a shorter period. Once it expires you can apply to renew it for a further 1 year. Grant of a Licence (1 year) – If you have never held a Dangerous Wild Animal Licence before or you do not currently have such a licence you need to apply for the Grant of a licence. The fee for a grant is £. Renewal of Licence (1 year) – If you currently hold a Dangerous Wild Animal Licence which has not expired but is due to expire then you need to apply for a Renewal of the licence. The fee for a renewal is £. The old licence remains in force until the renewal is granted, but only if application is made before the expiry date. If you are applying for the grant of a licence you are asked questions on the form as to whether you have previously held a licence in the United Kingdom or whether you have been refused such a licence previously. Please note it is very important that you complete these questions fully. D. PREMISES DETAILS You are required to supply the full postal address and telephone number of the premises to which the licence is to relate. Please also include the details of the accommodation being provided for the animal(s) E. ANIMAL DETAILS Please give details of all the animals in which it is proposed to keep at the premises please detail type, sex and number. F. KEEPER(S) DETAILS Please provide the full name(s) of all person(s) who will be acting as keeper(s) of the animals on behalf of the applicant. G. INSURANCE DETAILS Please provide details of the insurance policy held to cover liability, please include the name and address of the company, the policy number, expiry date and the amount of cover. LICENCE CONDITIONS APPLICABLE TO KEEPING A DANGEROUS WILD ANIMAL Conditions subject to which the licence is granted 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. That the animal(s) specified in the licence shall be kept by no other than the licence holder or, the person(s) named in the licence and designated by the licence holder to act as keeper(s) of the animal(s) on his or her behalf. That the applicant make the terms of the licence known to each person acting as a keeper on his or her behalf. That the applicant shall not increase the number of animals authorised by the licence to be in his possession without the consent of the authority. That the applicant possesses a valid insurance policy against liability for any injury caused by any animal specified in the licence. The applicant must not be disqualified for the time being under any of the following enactments:a) The Dangerous Wild Animals Act 1976 b) The Protection of Animals Acts 1911 to 1964 c) The Protection of Animals (Scotland) Acts 1912 to 1964 d) The Pet Animals Act 1951 e) The Animal Boarding Establishments Act 1963 f) The Riding Establishments Acts 1964 to 1970 g) The Breeding of Dogs Act 1973 That each animal specified in the licence shall at all times be held in accommodation which secures that it will not escape and, which is suitable as regards construction, size, temperature, lighting, ventilation, drainage and cleanliness and which is suitable in the provision of adequate exercise space That each animal specified in the licence be adequately supplied with suitable food and drink, be provided with suitable bedding material, be adequately exercised and (so far as is necessary) be visited at suitable intervals. Appropriate steps will, at all such times, be taken for the protection of any animal concerned in case of fire or other emergency. All reasonable precautions will be taken at all times to prevent and control the spread of infectious diseases. That immediate notification shall be made by the applicant or authorised keeper to the Police and to the Council in the event of any animal, to which the licence relates, escaping and being at large. That a notice be displayed at all times on any accommodation holding any animal specified in the licence, indicating that the occupant is a "Dangerous Wild Animal". That no animal, to which the licence refers, shall be kept at premises outside this District for a continuous period exceeding 72 hours unless previous notice of this intention has been given to both this Authority and the Authority in whose area those premises are situated and permission to do so has been obtained from both Authorities. PENALTY Any person guilty of an offence under any provision of this Act shall be liable on summary conviction to a fine not exceeding £400.00