Application for a licence to operate a dog breeding establishment

Application for a licence to operate a dog breeding establishment

The Animal Welfare (Licensing of Activities Involving Animals) Regulations 2018
Please complete all the questions in the form.
If you have nothing to record, please state "Not applicable" or "None"
Type of Application*
Existing licence number:

Animals to be accommodated
Where will the animals be accomodated:*
Breeds of dogs concerned:*
Number of Bitches kept*
Ownership*
Provide details of the ages of Bitches kept:*
Number of Studs kept*
Ownership*
Provide details of the ages of Studs kept:*

Premises to be licensed
Name of premises/trading name:*
Address of premises:*

Street Address

Street Address Line 2

Town/CityCounty

Post Code
Premises Phone Number:*
Please enter a valid phone number.
Email:*
example@example.com
Do you have planning permission for this business use?*

Accommodation and facilities
Heating arrangements:*
Method of ventilation of premises:*
Lighting arrangements (natural & artificial):*
Water supply:*
Facilities for food storage & preparation:*
Arrangements for disposal of excreta, bedding and other waste material:*
Isolation facilities for the control of infectious diseases:*
Fire precautions/equipment and arrangements in the case of fire:*
Do you keep and maintain a register of animals?*
How do you propose to minimise disturbance from noise?:*

Veterinary surgeon
Name of usual veterinary surgeon:

First NameLast Name
Company name:
Address:*

Street Address

Street Address Line 2

Town/CityCounty

Post Code
Phone Number:*
Please enter a valid phone number.
Email:*
example@example.com

Emergency key holder details
Name:*

First NameLast Name
Position/job title:*
Address:*

Street Address

Street Address Line 2

Town/CityCounty

Post Code
Daytime Phone Number:*
Please enter a valid phone number.
Evening/Other Phone Number:*
Please enter a valid phone number.
Email:*
example@example.com
Do you wish to add another Emergency Keyholder?
Name:*

First NameLast Name
Position/job title:*
Address:*

Street Address

Street Address Line 2

Town/CityCounty

Post Code
Daytime Phone Number:*
Please enter a valid phone number.
Evening/Other Phone Number:*
Please enter a valid phone number.
Email:*
example@example.com

Public liability insurance
Do you have public liability insurance?*
Insurance company:*
Policy number:*
Period of cover:*
Amount of cover (£m):*
Please state what steps you are taking to obtain such insurance:*

Disqualifications and convictions

Has the applicant, or any person who will have control or management of the establishment, ever been disqualified from:*

	Yes/No
Keeping a pet shop?
Keeping a dog?
Keeping an animal boarding establishment?
Keeping a riding establishment?
Having custody of animals?
Has the applicant, or any person who will have control or management of the establishment, been convicted of any offences under the Animal Welfare Act 2006?
Has the applicant, or any person who will have control or management of the establishment, ever had a licence refused, revoked or cancelled?

If you answered 'Yes' to any of the above, please provide details:*

Additional details
Additional information which is required or may be relevant to the application:

Declaration
I declare that the information given in this application is to my best knowledge and belief, correct, and understand that a false declaration could result in the licence applied for being revoked. I confirm that I have read and understood Surrey Heath Borough Council's Privacy Notice*

Please tick to confirm
Date*

DayMonthYear
Once we have received your completed application, our Environmental Services Team will be in contact with you to arrange an inspection and to take payment.
Privacy Statement

Details of Surrey Heath Borough Council’s Privacy Notice can be found here.
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