SCIENTIFIC PERMIT APPLICATION – FAUNA Issued under Section 29 of the Nature Conservation Act 2002 Regulation 4 of the Threatened Species Protection Regulations 1996 Regulation 18 of the National Parks and Reserved Land Regulations 1999 Section 46(1) of the Crown Lands Act 1976 Regulation 22 of the Crown Lands Regulations 2001 Part 3 of the Wellington Park Regulations 1999 Surname Department of Primary Industries, Parks, Water & Environment Given Names (in full) Title Organisation/Institution Street Address Ph (work) Fax (work) Proposed start date Email End date Short title of research project Full names and street addresses of all those directly involved with project including undertaking trapping/handling and assisting with research (attach a list if insufficient space) Location where animals are to be collected and specify the land tenure (PWS reserve, Crown land, private land, etc) Animal species involved (include scientific name) or list the groups of animals (eg birds, small mammals, insects, etc). Provide the numbers of each species involved What methods are to be used to take/collect animals (e.g. trapping, tagging, pitfalls, etc) (Note: bird or bat banding will require a current ABBBS licence) If animals are to be removed from site of capture, where are they taken and for how long? application form continued over page After Reading the “Guidelines for Issuing of Scientific Permits”, please tick relevant boxes Conservation benefits for the species can be clearly demonstrated by this research. Research contributes to scientific understanding (academic) of Tasmanian ecology but has no conservation benefits Research has the potential to benefit human health/medicine etc. Other species will be affected as a result of methods used e.g. pitfall trapping, mist netting. Sensitive ecosystems or communities will be affected by this research (collecting or study site). Research/collecting needs to be undertaken on reserved land. Research involves removing animals from the site and/or killing and/or housing in captivity. Research involves threatened species (check web site www.dpipwe.tas.gov.au). If it does, please make sure you have discussed this work with staff of the Threatened Species Section, Biodiversity Conservation Branch before applying for a permit, as special conditions may apply. Have you been issued with a scientific permit before? If yes, then you must have completed and submitted a report to Scientific.Permits@dpipwe.tas.gov.au before further permits will be issued. Animal Ethics Committee approval for research involving disturbance to vertebrate or higher invertebrate fauna. (Approval is required prior to issuing of permit. A copy of AEC approval and any associated conditions must also be attached to the permit application). AEC Number AEC Expiry Date Not Applicable YOU MUST PROVIDE WITH THIS APPLICATION: Electronic one page summary of proposed research (proforma at www.dpiw.tas.gov.au/scientificpermits) and emailed to Scientific.Permits@dpipwe.tas.gov.au. This will also be posted on our website for a two week public comment period. If AEC approval is required for your research, please provide a copy of your AEC application, AEC approval, AEC number and any conditions imposed by AEC. (If your institution is not based in Tasmania confirm that your AEC is licensed under the Tasmanian Animal Welfare Act). Signature of Applicant Date (verifying information provided is comprehensive and accurate) Please Read Carefully: The Secretary retains the authority to reject any permit application and also to apply conditions to any permit issued. Allow 4 weeks for from receipt of application to complete the permit assessment process. Permission must be sought from the relevant land manager(s) to access land. To remove wildlife from Tasmania requires an export permit available from the Wildlife Management Branch, Department of Primary Industries and Water, GPO Box 44, Hobart TAS 7001. Ph (03) 61654305 Email permit applications to: Scientific.Permits@dpipwe.tas.gov.au Contact Details: Scientific Permits, Biodiversity Conservation Branch, Department of Primary Industries Parks, Water and Environment, GPO Box 44, Hobart TAS 7001. Ph (03) 6165 4316 or 6165 4319. 1. Personal information will be collected from you for the purpose of managing Tasmania’s wildlife and will be used by DPIPWE for assessing, considering, advising upon, managing and/or determining the relevant application and may be used for other purposes permitted by the Crown Lands Act 1976, National Parks and Reserves Management Act 2002, Nature Conservation Act 2002, Threatened Species Protection Act 1995 and Wellington Park Act . 1993 and regulations made under these Acts. 2. You are required to provide this information by the Crown Lands Act 1976, National Parks and Reserves Management Act 2002, Nature Conservation Act 2002, Threatened Species Protection Act 1995 and Wellington Park Act 1993 and regulations made under these Acts. Failure to provide this information may result in your application not being able to be processed or the service not being able to be provided. 3. Your personal information will be used for the primary purpose for which it is collected, and may be disclosed to contractors and agents of the Resource Management and Conservation Division, law enforcement agencies, courts and other organisations authorised to collect it. 4. Your basic personal information may be disclosed to other public sector bodies where necessary, for the efficient storage and use of the information. 5. Personal information will be managed in accordance with the Personal Information Protection Act 2004 and may be accessed by the individual to whom it relates on request to DPIPWE. You may be charged a fee for this service.