For Office Use
Licence Ref. No.
Visited
Officer
Veterinary
Inspection
Allerdale Borough Council
Food & Occupational Health Team
Allerdale House
Workington
CUMBRIA
CA14 3YJ
Licence Issued
The Pet Animals Act 1951
Please complete in BLOCK CAPITALS and BLACK INK
Form of Application for Licence or Licence Renewal for a Pet shop
In accordance with the Pet Animals Act 1951
I would like to apply for (*please
tick as appropriate)
Renewal of an existing
licence
A Licence
Your full name
Title (State whether
Mr/Mrs/Miss/Ms/other etc)
Date of Birth
Private Address (or, if a Body
Corporate, name of Body and
Address of Registered Office)
Postcode
Telephone number
Address of Pet shop including
trading name
(if different from above)
Post code
Email address
Telephone number
Normal opening hours
Who will have direct control or
management of the Pet shop?
Does the person in control of the
premises hold any
certificates/qualifications or
experience in animal husbandry.
Pet Shop licence
(Continue on a separate sheet if necessary).
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What arrangements are there in
case of emergency including fire?
Will the carrying on of the animal boarding business be at all times in the charge of a Yes / No
person of the age of 16 years or over?
Will supervision by a responsible person of the age of 16 years or over be provided
at all times while the establishment is in operation?
Yes / No
The applicant is required to answer “Yes” or “No” to the following questions:Are you or any person who will have control or management of the establishment,
disqualified for the time being from:
(a) Keeping a riding establishment?
Yes / No (b) Keeping a dog?
(c) Keeping a pet shop?
Yes / No
Yes / No
(d) Having the custody of
animals?
Yes / No
(e) Keeping a boarding
Yes / No
establishment for animals?
Are you the holder of a current insurance policy which includes public and
Yes / No
employers liability if staff are employed
Who are you insured with?
Details of the accommodation
Type of Animal
Proposed
numbers
Details of
accommodation
Age at which
proposed to be sold
Parrots
Pigeons
Other large birds
Budgerigars, finches and
other small birds
Dogs
Cats
Rabbits and cavies
Hamsters
Rats, mice and gerbils
Tortoises
Snakes and lizards
Fish – Tropical
Pet Shop licence
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Fish – Marine
Fish – Cold Water
What arrangements are available for:-
Storing Food and Bedding
Temperature control and
monitoring
Collection and disposal of waste
Vaccination and infection control
Cleaning and disinfection
Exercise
Pest control
What is the name and address of your usual veterinary surgeon/practitioner?
Name
Practice
Address
Postcode
Pet Shop licence
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For any new applications or variation, please include a scale plan of the establishment
showing each of the accommodation and exercise areas.
I am aware of my obligations as a licence holder under the provisions of the
The Pet Animals Act 1951
I apply for (*please tick as
appropriate)
New Licence
Renewal
Establishment Commencing
(new licence)The First Day Of:
I enclose the licence fee of
(renewal)January
20…..
£
Please make cheques payable to ALLERDALE BOROUGH COUNCIL.
New Licence applicants and those requiring a variation to the previous licence will be invoiced
for the cost of their veterinary inspection when their licence is issued.
I understand that I am liable for any fees relating to the inspection of my proposed premises by
Veterinary Surgeons, Local Authority Officers, Fire Brigade personnel or any other relevant
authority. The current licence fee is reviewed annually and is additional to the above.
(Read the following statement carefully before signing it. A false statement may render you liable to
prosecution).
I declare my answers to the above question to be correct in every respect
Signature
Date
If signing on behalf of a Body Corporate, state appointment held:
Data Protection Act
The information provided will be used to process your application. It will be shared with other
organisations where we are obliged to by law.
Please contact us if you require this form in large print.
Pet Shop licence
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