APPLICATION FOR A LICENCE TO KEEP A 
BOARDING ESTABLISHMENT FOR ANIMALS		
ANIMAL BOARDING ESTABLISHMENTS ACT 1963	

DETAILS OF APPLICANT	
First Name(s):	
Surname:	Title:	
Postal Address:	
Phone (Home):	Phone (Mobile):	
Email address:	
Date of Birth:	National Insurance No.:	

DETAILS OF ESTABLISHMENT	
Trading Name:	
Address of Premises:	

NUMBER OF ANIMALS TO BE ACCOMMODATED	
Cats:	Dogs:	

PLEASE GIVE INFORMATION ABOUT THE ACCOMMODATION THAT THE ANIMALS WILL OCCUPY	
Construction:	
Number and size of the quarters in which the animals are/will be accommodated:	
Heating arrangements:	
Method of ventilation:	
Exercising facilities:	
Lighting arrangements:	
Water supply:	
Arrangements for the storage of food:	
Arrangements for the disposal of excreta:	
Description of isolation facilities for the control of infectious diseases:	

DISQUALIFICATIONS	
Are you, or have you ever been, disqualified from:	
Keeping an animal boarding establishment	Yes	No	
Keeping a dog	Yes	No	
Having the custody of animals	Yes	No	
Keeping a pet shop	Yes	No	
Keeping any dangerous wild animals	Yes	No	
Keeping a riding establishment	Yes	No	
Keeping a dog breeding establishment	Yes	No	

VETERINARY SURGEON DETAILS	
Name and address of veterinary surgeon	

DECLARATIONS	
I understand that the Authority is under a duty to protect the public funds it administers, and to this end may use the information I have provided on this form for the prevention and detection of fraud.  I understand that it may also share this information with other bodies responsible for auditing or administering public funds for these purposes.
I declare that the information given above is true to the best of my knowledge and that I have not wilfully omitted any necessary material. I understand that if there are any wilful omissions, or incorrect statements made, my application may be refused without further consideration or, if a licence has been issued, it may be liable to immediate suspension or revocation.
I understand that the Authority is collecting my data for the purposes described on this form and will not be used for any other purpose, or passed on to any other body, except as required by law, without my consent.	
Signature:	
Print Name:	
Date:	

Please return your completed form with any relevant supporting documents and the appropriate fee
 (made payable to Redditch Borough Council) to either:	
Licensing
Redditch Borough Council
Town Hall
Walter Stranz Square
Redditch
Worcestershire
B98 8AH
	Worcestershire Regulatory Services
Wyre Forest House
Finepoint Way
Kidderminster
Worcestershire
DY10 1NW 
Email: wrsenquiries@worcsregservices.gov.uk
Telephone: 01905 822799