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APPLICATION FOR FAUNA POSSESSING (PET KEEPER’S) LICENCE

Page 1 of 3 APPLICATION FOR FAUNA POSSESSING (PET KEEPER S) LICENCE (Pursuant to Regulation 36 of the Biodiversity Conservation Regulations 2018) Complete 1A OR 1B 1A. Applicant details - INDIVIDUAL Mr / Mrs / Ms / Dr First Name Other names (middle) Surname Residential Address Suburb Postcode State Postal Address Suburb Postcode State Email: Date of Birth ____/____/_____ Phone Contact No. Previous Lic. No. Proof of identification (photo identification required, eg, driver s LICENCE , passport) Attached 1B. Applicant details COMPANY / BODY CORPORATE Company Name Business Address Suburb Postcode State Postal Address Suburb Postcode State Email: Date of Birth ____/____/_____ Phone Contact No. Previous Lic. No. Name of contact person Proof of identification (eg. ABN, ACN registration documentation) Attached Refer Responsibility of certain persons, Biodiversity Conservation Act 2016 Part 13 Div 2 for liability information NOTE TO ALL APPLICANTS: The LICENCE to which this APPLICATION relates replaces: Avicultural and advanced avicultural licences ( LICENCE to breed and keep avian FAUNA ) Wildlife Conservation Regulations 1970 Reg 12 Herpetofauna keeper s LICENCE (Pet herpetofauna LICENCE ) Wildlife Conservation ( reptiles and Amphibia)

Reptiles Amphibians Information to new applicants applying for Advanced (Cat C) for dangerous reptiles: For Category C reptiles specified as dangerous (denoted with *) please attach: 1) Shire approval which acknowledges possession of dangerous reptiles at …

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