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Domestic Animal Business Permit Application Form

Domestic Animal Business Permit Application

"*" indicates required fields

Step 1 of 2

Section one: Applicant details

Name*

First Last

Mailing address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Is your residential address the same as your mailing address?*

Yes

Residential address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Telephone (Business Hours)*

Mobile phone

Email*

Business details*

Business name*

Business address*

Section two: Type of permit

Type of permit*

Breeding and rearing establishment

Pet shop

Boarding establishment

Training establishment

Pound

Section three: Insurance requirements

The permit holder must ensure they are adequately covered by Public Liability Insurance. To meet Council requirements, the policy must note Council’s interest and be for an amount not less than $20,000,000 in respect of any single occurrence.

Section four: Indemnity clause

This applicant agrees to indemnify and keep indemnified Moonee Valley City Council (Council), its servants and agents and each of them from and against all actions, costs, claims, charges, expenses, penalties, demands and damages whatsoever which may be brought or made or claimed against them, or any of them, arising out of or in any way related to the granting of this permit and be directly related to the negligent acts, errors or omission of the applicant.

The applicant’s liability to indemnify Council shall be reduced proportionately to the extent that any act or omission of Council contributed to the loss or liability. The applicant also agrees to hold harmless Council, its servants and agents, and each of them from claims resulting from damage, loss, death or injury whatsoever which may otherwise be brought or made or claimed by the applicant against Council, except to the extent that the principal is negligent.

Section five: Declaration

I confirm that the above information is true and correct. I agree to abide by all terms and conditions specified in the permit. I acknowledge that the use of the permit shall be in accordance with the Domestic Animals Act 1994. Note: Under Section 97 of the Domestic Animals Act 1994 it is an offence for a person making an application to give false information. Penalty: 5 Penalty Units. (1 penalty unit = $ 161.19).

Section six: Privacy Statement

The personal information on this form is being collected by Moonee Valley City Council to enable the processing of a Domestic Animal Business permit and for the purpose of administration of relevant acts, regulations and local laws. The personal information will be used by Moonee Valley City Council for that purpose or directly related purposes only. The information will not be released unless required by law. The applicant may apply to Moonee Valley City Council for access to and/or amendments of the information.

Supporting Documentation

Max. file size: 256 MB.

Name*

Signature*

Date*

Section six: Fees and payment

A permit fee, in accordance with current Council fees and charges, will apply should the permit be approved. An invoice will be issued upon approval of any permit.

Domestic Animal Business Permit Application Form