ÐÏà¡±á>þÿ >µþþÿÿÿ;<=ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿì¥Á ø¿µ*bjbj¨¨ ´¥Êh1gÊh1g "ÿÿÿÿÿÿ·ššVVVÿÿÿÿjjjjìVLjd[z¢!Lî!î!î!î!í3®›44Ï4ãZåZåZåZåZåZåZ$Þ_¶”bj [Vë4S3ší3ë4ë4 [ššî!î!e[787878ë4š†î!Vî!ãZ78ë4ãZ78786QTà 6Vî!ÿÿÿÿpø/TYØÿÿÿÿ5¾1UÏZ4[0d[MU`þb¿5Nþb8VVîþbV›W4ë4ë478ë4ë4ë4ë4ë4 [ [ 7*ë4ë4ë4d[ë4ë4ë4ë4ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿþbë4ë4ë4ë4ë4ë4ë4ë4ë4X`: The Animal Welfare (Licensing of Activities Involving Animals) (England) Regulations 2018 APPLICATION FOR A LICENCE TO SELL ANIMALS AS PETS APPLICANT DETAILS (Applicant must be the individual(s) who will carry on the licensable activity) To be completed in BLACK ink * Please delete as appropriate – Full Name of Applicant Please indicate title (i.e. Mr, Mrs, Miss, Ms etc.) Address of Applicant Postcode We will use this address for correspondence unless you say otherwiseDate of Birth for Applicant Contact Numbers for ApplicantLandline Mobile Email Address for Applicant(s) YESNOHas the applicant, or any person who will have control or management of the establishment, ever been disqualified from keeping a pet shop?Has the applicant, or any person who will have control or management of the establishment, ever been disqualified from keeping a dog?Has the applicant, or any person who will have control or management of the establishment, ever been disqualified from keeping an animal boarding establishment? Has the applicant, or any person who will have control or management of the establishment, ever been disqualified from keeping a riding establishment?Has the applicant, or any person who will have control or management of the establishment, ever been disqualified from 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 Yes, to any of the above then please provide details:- YESNODo you have planning consent for business use?Is your business certified by a UKAS-accredited body with 3 or more years of compliance history? Do you have public liability insurance? If NO please state what steps you are taking to obtain such insurance. If YES please provide the following details:- Policy Number:- Period of Cover:- Amount of Cover:-Please provide dates (next 10 weeks) when the premises will not be available for inspection. PREMISES TO BE LICENSED Name of Business / Trading Name (if any) Address of Premises to be licensed (if different to applicant details) PostcodePremises Contact Numbers (if different to applicant details) Landline Mobile Premises / Business Email (if different to applicant details) Website Address for Premises / Business Will the premises be operative throughout the year?Please provide details What are the opening times of the premises? Which type of business is to be operated? YESNO Pet Shop Home Sales Wholesales Third Party Sales Hobby Sales (Pet Fairs) Sale of animals to the public as pets by means of a fixed donation If other then please state………………………………… ACCOMMODATION AND FACILITIES Number and size of rooms to be used Heating arrangements Method of ventilation for the 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 case of fire Do you keep and maintain a register of animals? ANIMALS TO BE SOLD Please complete the boxes below for each type of animal to be sold TypeMaximum Number Details of Accommodation and SizeAge at which to be soldDogs/Puppies Cats/Kittens Chipmunks Rabbits & Cavies Hamsters Rats, Mice & Gerbils Parrots, Parakeets and MacawsPigeons Other large birds (please specify)Budgerigars, Finches and other small birdsTortoises Snakes and Lizards Tropical Fish Marine Fish Cold Water Fish Any other species (please specify MANAGEMENT OF THE PREMISES When the premises are closed what arrangements are in place to ensure the welfare of animals? What are the arrangements in the event of an emergency? Does the applicant have any training certificates or qualifications? Please provide details. State “none” if that is the case. Please provide details of relevant experience VETERINARY SURGEON Name of usual veterinary surgeon Company Name Full Address Telephone Number Email address EMERGENCY KEY HOLDER YESNODo you have an emergency key holder? If YES please provide details below. Name Position / Job Title: Address: Postcode: Daytime Telephone No: Evening / Other Telephone No: Email address: GUIDANCE AND ADDITIONAL INFORMATION It is recommended that you read the procedural guidance notes published by the Department for Environment, Food & Rural Affairs (DEFRA) for local authorities. DEFRA has also published guidance in relation to all licensable activities which includes the conditions of licence that will be imposed if a licence is issued. The guidance can be found under legislation and guidance on the Canine and Feline Sector Group, by accessing the link below. The guidance documents will be useful to applicants and operators as they explain the licensing requirements, conditions of licence, inspection of premises together with information relating to how the star rating and length of licence to be issued will be determined by the Council. HYPERLINK "https://www.cfsg.org.uk/" CFSG – CANINE AND FELINE SECTOR GROUP Please provide any additional information which is required or may be relevant to the application Please read the information below and then proceed to the declaration section and provide any necessary documents. PRIVACY NOTICE The information you provide is confidential and subject to the requirements of the Data Protection Act 2018. This personal data will be held and processed by ¶®ÒõµÛ for the purpose(s) of licensing and enforcement and protection of public funds. (The personal details you provide may also be shared with a veterinary Surgeon / practitioner, DEFRA, RSPCA, UKAS-accredited body, Planning Service, Council Legal Team and the licencing committee. For the purposes of or as part of any statutory duties requiring such disclosure and to protect the public funds it collects and administers.)Any data may be used to prevent fraud or the misuse of resources. For further information of our privacy notice, please visit HYPERLINK "http://www.birmingham.gov.uk/privacy" www.birmingham.gov.uk/privacyThe direct link to the BCC full privacy notice is: HYPERLINK "\\\\ENVCL01\\RS$\\Public Health\\AONorth\\EHO\\vikki\\The Animlas Welfare (Licensing of Activities Involving Animals) (England) Regulations 2018\\Cornwall Council application forms\\in order for us to locate any further information that may be held about you."www.birmingham.gov.uk/privacy DECLARATION I agree to permit an officer and / or a veterinary surgeon or veterinary practitioner authorised by the Council to inspect the premises which are the subject of this application. I declare that the details contained in the application form and the attached documentation is correct to the best of my knowledge. I also confirm that I read and understand the privacy notice and that I am aware of the provisions of the relevant legislation and the model licence conditions which I will comply with at all times and that I have read and understand the privacy notice. Date Signature of Applicant Please attach / provide the following information with your application. Layout / outline plan of the premises (unless we have this already and the layout has not changed) The following may also need to be seen / inspected. It would be helpful to receive them with your application as it may save time later, particularly during the licence inspection:- Insurance policy Qualifications Details / evidence of certification by a UKAS-accredited body with there or more years compliance history Please send your application and supporting information to the address below. Payment will be taken after the length of licence has been determined (one, two or three years) and will depend on the outcome of inspection. Senior Animal Health & Welfare Officer Regulation & Enforcement City Operations Directorate PO Box 17831 BIRMINGHAM B2 2HJ Tel: 0121 303 9918 Email: HYPERLINK "mailto:vikki.allwood@birmingham.gov.uk" vikki.allwood@birmingham.gov.uk New Renewal abqr‹“”•–âÏÏÏÏÏ¼ª••€n\J**>jh.mt5B*CJOJQJU_HaJmHnHphÿtH u"h:Æ5B*CJOJQJaJphÿ"hÙM5B*CJOJQJaJphÿ"hÔB 5B*CJOJQJaJphÿ(h´#˜h#Y½5B*CJOJQJaJphÿ(h´#˜hì@5B*CJOJQJaJphÿ"hú W5B*CJOJQJaJphÿ$h´#˜hœ=5B*CJOJQJphÿ$h´#˜hì@5B*CJOJQJphÿ:jhÌ-5B*CJOJQJU_HmHnHphÿtH uab”—š›œ®¯ ^ ` úúúúúúúúúúúúëëëëßÓÓ$*$1$Ifgdú W$*$1$IfgdŠs‹$$*$1$Ifa$gd#Y½$a$–—˜™š›œ®¯ÐÓØâ îÎÎ¼¼ „ h L -<h´#˜hú W5B*CJOJPJQJ^J_HaJnH phÿtH 6hµÜ5B*CJOJPJQJ^J_HaJnH phÿtH 6h£#5B*CJOJPJQJ^J_HaJnH phÿtH 6h#Y½5B*CJOJPJQJ^J_HaJnH phÿtH 6hú W5B*CJOJPJQJ^J_HaJnH phÿtH "h.mt5B*CJOJQJaJphÿ>jh.mt5B*CJOJQJU_HaJmHnHphÿtH u"hú W5B*CJOJQJaJphÿ = ] ^ _ ` a f åÈ©ÈŒÈåÈmN19h´#˜hÑ×B*CJOJPJQJ^J_HaJnH phÿtH <h´#˜hH«5B*CJOJPJQJ^J_HaJnH phÿtH <h´#˜hŠs‹5B*CJOJPJQJ^J_HaJnH phÿtH 9h´#˜hŠs‹B*CJOJPJQJ^J_HaJnH phÿtH 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