Animal Registration

(Animal management Act 2008 Sections 46,47,54 & 55)

New Registration

Renewal of Registration

Change of registration details

Applicant Details
Full Name
Residential Address
Postal Address
Telephone
Email
Application Date

Animal Details
Name
Registration Type
Breed
Year of Birth and Age
Sex
Desexed
Colour
Distinguishing Marks
Registration No.
Microchip id No.
Address Animal is Kept
if diff to above

Dog

Cat

Male
Yes

Female
No

Yes

No

Regulated Dogs Only

Restricted Dog
Restricted dog permit no.

Dangerous Dog

Menacing Dog

Declaration
I apply for the registration of the dog/cat described above and declare that the particulars are correct in
every detail
Applicants signature
Date

Office Use Only

Vet Desexed Cert attached
New tag No.

BCS/L&E/R/D&C

Registration Fee Paid

Receipt No.

Additional Info Required

Date Recd