APPLICATION FOR A LICENCE TO KEEP DANGEROUS WILD ANIMALS
DANGEROUS WILD ANIMALS ACT 1976
Return the completed form to :Place Department,Licensing Team,10th Floor, Zone
B,Bernard Weatherill House,8 Mint Walk,Croydon,CR0 1EA. Tel no 0208 760 5466
1. APPLICANT/S
a) First Name ……………………………………………………………………..
b) Last/Family Name: …………………………………………………………….
c) Full Home Address of Applicant :………………………………………………
………………………………………………………………………………………….
d) Home Tel No : ………………………. e) Mobile No: ……………………………..
f) E mail address: …………………………………………………………………..
g) Date of Birth:……………………………
2) PREMISES WHERE ANIMALS WILL BE KEPT (if different to the above)
a) Address: ……………………………………………………………………
……………………………………………………………………………………
c) Tel No :…………………………
d) Species of animals to be kept ……………………………………………………
(a separate schedule may be attached if necessary)
……………………………………………………………………………………….
I declare that the applicant is over 18 and has not been disqualified from keeping
animals . I declare that the information given on this form is accurate to the best of
my knowledge.
Signature of applicant/s:…………………………………….Date ; ………………………..
Office Use only: Uniform No …………………………………….
Receipt No:……………………………….Date Received …. ……………………….
SF.C118/07/15