Ballymena Borough Council

04 February 2012

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Please note fields marked with a * are mandatory.

Title:

* Full First Name: (min. 3 characters)

* Last Name:

* Address:

* Postcode:

* Telephone:

* E-mail:

Address of premises where dog is kept (if different to above):

Previous License No:

Date of Expiry:

DESCRIPTION OF DOG

* Breed:

* Colour:

* Distinguishing Marks (if any):

* Sex:

* Is dog sterilised:

* Name of Dog (if any):

* Age:

Microchip number:

Fees and concessions	Please Tick	Fee required
Please select one option:
I am eligible for a free licence as I am over 65 and this is the first or only dog I keep.	Insert Date of Birth	None
I am over 65 and have already claimed a free licence for one dog.		£5.00
I am in receipt of an income-related benefit (within the meaning of the Social Security Administration (Northern Ireland) Act (Northern Ireland) 1992 (c.8)) at the time of the application for the licence.	Housing Benefit Income Support	£5.00
The dog described above is sterilised.		£5.00
None of the above.		£12.50

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 above dog? :
If YES, please give the serial number of 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:
The date of that court order: 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:
DECLARATION
NOTE: The information given above may be subject to checks. I declare that the information given above is correct in every respect. I am not under 16 years of age and I have not been disqualified from keeping a dog. I understand and accept all of the above.

Our refunds policy

All refunds will be issued within 10 working days of receipt of a valid claim, payments will be made by cheque or BACS, no cash refunds will be issued.

Company Details

Ballymena Borough Council
"Ardeevin"
80 Galgorm Road
Ballymena
BT42 1AB
Tel 02825 660300

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