Fermanagh District Council
The Dogs (Northern Ireland) Order 1983 - Application for a Dog Licence
Details of applicant
Title
*
Please Select
Mr
Mrs
Miss
Ms
Dr
Forename/s
*
Surname
*
Street Address
*
Street Address Line 2
City / Town
*
Postcode
*
E-mail
Phone Number
*
-
Area Code
Phone Number
Address at which dog is kept (if differrent from above)
Street Address
Street Address 2
City / Town
Postcode
Description of dog
Colour
*
Breed
*
Sex
*
Please Select
Male
Female
N/A
Is the dog sterilised ?
*
Please Select
Yes
No
Age
*
Distinguishing Marks (if any)
Microchip number
*
Name (if any)
Date of Expiry licence (if any)
Number of previous licence (if any)
If you have not yet possession of the dog, date you intend to
Control Conditions
Is a notice in force attaching control conditions under Article 30A(2) of the Dogs (NI) Order 1983 to a previous licence held in respect of the dog?
yes
no
If Yes, please give the serial number of that notice
Exemption for prohibited types
Is the dog above subject to a contingent destruction order under Article 25C(4) or Article 33(1B) of the Dogs (NI) Order 1983? If yes, please give either
*
Please Select
Yes
No
The date of that court order or
The Serial Number of an exemption certificate issued in respect of the dog
It is a requirement that a policy of third party insurance is in force in respect of any exempted dog. Please Supply : Policy Provider
Policy Number
Do you want to add another dog?
yes
no
Enter Information for Dog Nº 2
Colour
*
Breed
*
Sex
*
Please Select
Male
Female
N/A
Click to edit
Payment section
Description
*
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( X )
I am eligible for a free licence as I am over 65 and this is the first or only dog I keep
£
Free
Nº of dogs
1
2
3
4
I am over 65 years old and have already claimed a free licence for one dog
£
5.00
Nº of dogs
1
2
3
4
I am in receipt of an income-related benefit ( within the meaning of Social Security Administration (Northern Ireland) Act (Northern Ireland) 1992* (c. 8)) at the time of the application for the licence.
£
5.00
Nº of dogs
1
2
3
4
The dog described is sterilised.
£
5.00
None of the above
£
12.50
Nº of dogs
1
2
3
4
Total
£
0.00
Fees and concessions - Select appropriate (One only)
*Income-related benefit means Income Support and Housing Benefit.
Warning
An applicant for a licence who knowingly and wilfully makes a statement on this form which is false in a material particular is liable to prosecution. I declare that the information given above is correct in every respect and that I am not under 16 years of age and that I have not been disqualified from keeping a dog under Art 33A Dogs (NI) Order 1983 or Animal Welfare Legislation.
Data Protection Act 1998
Fermanagh District Council collects the data on this form for the purposes of the management and application of the Dogs (Northern Ireland) Order 1983. This data may also be passed to other relevant Government agencies.
Submit Form (By clicking I have read and accept the terms)
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