Isle of Wight Council

	APPLICATION FOR A LICENCE TO KEEP A DOG BREEDING ESTABLISHMENT
	Breeding of Dogs Act 1973 and 1991 Breeding and Sale of Dogs (Welfare) Act 1995
	Please read the Terms and Conditions
	This licence fee is not refundable in the event of the application being refused or otherwise.

Personal Details

*	Forename(s)
*	Surname

*	Building/house name/number
*	Street
*	Town
	County
*	Postcode
	Telephone number (include area code)
	Mobile telephone number
	Email address
	Fax

Establishment Details

	Breeds of dogs
	Number of bitches kept
	Ages of bitches kept

Please give the following information about the accommodation which the dogs will occupy:

	Construction
	Size of quarters
	Number of occupants
	Heating arrangements
	Lighting arrangements
	Food storage and water facilities

	Arrangements for disposal of excreta
	Exercising facilities
	Please provide details of any training and/or practical experience in handling the animals concerned of yourself or staff
*	Have all necessary planning permissions been obtained?	Yes No
	If 'yes', please quote reference numbers

	Previous Convictions
*	Please indicate whether you have ever been convicted of any offence under the following legislations: Protection of Animals Acts 1911-1964 Protection of Animals (Scotland) Acts 1912-1964 Pet Animals Act 1951 Animal Boarding Establishments Act 1963 Riding Establishment Acts 1964 and 1970 Breeding of Dogs Act 1973 Dangerous Wild Animals Act 1976 Any other animal welfare legislation Yes No

If 'yes', please give details

	You are responsible for the payment of the fee for the vet inspection. Note: the licence will not be issued until the vet�s fee is paid in full. This form must be signed and presented to the licensing section before a decision is made and the licence may be granted. Either print off the completed form, sign and post to the licensing department or attend council offices to sign after you have submitted the form online The application fee is not refundable in the event of the application being refused or otherwise.
	Declaration
	I declare that I have checked the information given on this application form and to the best of my knowledge and belief it is correct. I understand that a false or misleading statement, or that withholding relevant information, may result in the refusal or revocation of the licence and\or may render me liable to prosecution. Signed ............................................................................... Name................................................................................. Date...................................................................................

	Data Protection Act 1998
	This application may be monitored by the Isle of Wight Council for regulatory, quality control or crime detection purposes. Information from this application will be processed in accordance with the Data Protection Act 1998 for the purpose of processing your particular enquiry/request. The Isle of Wight Council ("the Council") is the data controller. By completing this form you consent to the Council contacting you by email or nominated contact method in relation to your enquiry/request. The information contained in this application may, in exceptional circumstances, be subject to disclosure to third parties under either the Data Protection Act 1998 or the Freedom of Information Act 2000 to the extent the law allows and in accordance with the Isle of Wight Council's Access to Information Policy . Disclosure will only be made where in all the circumstances it would be fair to do so and in the public interest. Please note that the Council may process your information in the absence of consent for the purpose of crime prevention or detection so far as is in accordance with the law. Sometimes we may use your information to keep you informed about services, goods or relevant issues that we believe may be of interest to you. If you wish to receive this information for these purposes please tick this box To improve the quality of other services that we provide to you the Council wishes to hold your non-sensitive personal information on a secure central database. This will enable all Council services to use this information when they are providing a service to/for you. If you wish your non-sensitive personal information to be held by the Council please tick this box