Application to register a dog 2014/2015

Application to register a dog(s)
For the year 1 July 2014 - 30 June 2015
(Under section 36, Dog Control Act 1996)
Step 1: This application is for a:
New registration
Registration transfer
Replacement tag
Step 2: Complete your owner details
Full name:
Owner date of birth:
/
/
Second owner full name (if applicable):
Second owner date of birth:
/
/
Address:
Postcode:
Home ph:
Mobile:
Business ph:
Email:
Address where dog is usually kept (if different from above):
SuperGold Community Services (CSC) combo card number:
Refer to information on the reverse of this form
Step 3: Complete your dog(s) details
Particulars of dog
Dog one – details
Dog two – details
Dog three – details
Breed
Primary:
Secondary:
Primary:
Secondary:
Primary:
Secondary:
Age
Years:Months:
Years:Months:
Years:Months:
Colour
Primary:
Secondary:
Primary:
Secondary:
Primary:
Secondary:
Dog name
Dog reference
Sex
Male Female
Male Female
Male Female
Neutered
Yes
No
Yes
No
Yes
No
Disc
Strap
Disc
Strap
Disc
Strap
Microchip number
Distinguishing marks/
tattoo
Registration class
Tag preference (please tick)
Step 4: Transfer details (if you are not transferring a dog registration go to step 5)
If you are transferring your dog registration from a council outside of Auckland, please complete the fields below.
Council currently registered with
Current tag number
For office use only.
New tag number: Dog one
Dog two
Dog three
Fee: Dog one $
Dog two $
Dog three $
Receipt number:
Please do not separate. Return both portions.
Total fees payable
Dog one
Dog two
Dog three
Total fee $
$
$
$
(GST inclusive) See payment options on the reverse of this form
BC3438
Step 5: Owner classifications
Please tick the appropriate box if any of the following classifications apply under the Dog Control Act 1996.
One or more of your dogs is classifed as ‘dangerous‘ Dog name(s): ��
One or more of your dogs is classified as ‘menacing‘ Dog name(s): ��
A menacing dog is classified under section 33A or section 33C of the Dog Control Act 1996. A dangerous dog is classified under section 31 of the Act.
Step 6: Signature of applicant
I certify that I have read this form and at the time of signing, the particulars included are, to the best of my knowledge, true and
correct. I understand that failure to supply information or giving false information may result in further action.
Signature of dog(s) owner: Class
Date:
Registration of class
Before/on 1 August 2014
After 1 August 2014
A
Standard fee
$134
$164
B
Responsible Dog Owner Licence with de-sexed dog
$60
$126
C
Responsible Dog Owner Licence with entire dog
$69
$164
D
De-sexed dog (no Responsible Dog Owner Licence)
$96
$126
E
With SuperGold Community Services (CSC) combo card
$60
$75
F
Special category dog
-
-
G
Working dog
$30
$37
H
Classified dangerous dog
150% of the fee that applies 150% of the fee that applies
Replacement tag fee
$8
$8
Payment options
In person:
Cash, cheque, Eftpos or credit card
(MasterCard or Visa)*
At any Auckland Council service centre. For
opening hours visit www.aucklandcouncil.govt.nz
By post:
Cheque
Make cheques payable to Auckland Council
Auckland Council
Private Bag 92300, Auckland 1142
*Credit card payments will incur a surcharge of 2 per cent of your payment amount.
What you need to know
• The information requested in this form is needed to register your dog(s). You must notify Auckland Council of any change of address or
change in ownership of the dog(s).
• Your date of birth is required by the Dog Control Act 1996; it enables us to distinguish you from other persons with the same name.
• If your dog is neutered please provide a copy of a veterinary certificate with application to receive the relevant discount.
• You will receive a tag once you have completed the application process and we have received your payment.
SuperGold Community Services (CSC) combo card
If you hold a SuperGold Community Services (CSC) combo card, please either (a) bring your CSC combo card, payment and ‘Application
to register a dog(s)’ form to one of our service centres or (b) post your ‘Application to register a dog(s)’ form and payment, including a
photocopy of both sides of your CSC combo card. (Please do not post your actual card).
Important privacy information
Your information is required under the Dog Control Act 1996 to register your dog(s). Failure to provide the requested information will
result in your dog not being registered, which is an offence under the Act. Section 35 of the Act allows any person to apply in writing for
the name and address of the owner of any specified dog. Auckland Council is required to provide that information where it is satisfied
of that person’s identity and that the information is required for one of a limited number of purposes specified in section 35(5), such as
returning a lost dog to its owner or seeking compensation for damage.
The personal information that you provide in this form will be held and protected by Auckland Council in accordance with our privacy
policy (available at www.aucklandcouncil.govt.nz/privacy and at our libraries and service centres) and with the Privacy Act 1993. Our
privacy policy explains how we may use and share your personal information in relation to any interaction you have with the council, and
how you can access and correct that information. We recommend you familiarise yourself with this policy.
For more information about your legal obligations as a dog owner, refer to the ‘Information relating to dog registration’ page, visit
www.aucklandcouncil.govt.nz/dogs or phone 09 301 0101.
Your receipt
Dog name
Dog reference
New Strap/Disc #
(For office use only)
Please do not separate. Return both portions.
Receipt number
(office use only)
Office
stamp here

Download Report