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August 5, 2024

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Animal registration – new application for dog

Application for Dog New Registration

"*" indicates required fields

I declare that :

a. I am not, or the Owner is not, under eighteen years of age;

b. The particulars shown in this application are true to the best of my knowledge and belief; and

c. I certify for the purpose of Sect 16 (1a) of the Dog Act 1976, that means exist on the premises at which the dog will ordinarily be kept for effectively confining the dog within those premises.

d. I certify for the purpose of Sect 16 (3a) of the Dog Act 1976, I have not been convicted of an offence under the Cat Act 2011, Dog Act 1976 or Animal Welfare Act 2002 within the last 3 years.

e. I am not currently banned, or have ever been banned from owning a dog under the Dog Act 1976 either permanently or for a period specified.

Dog's Details

Premises kept (where will the animal ordinarily be kept)*

Dog's Detail*

Animal Name

Breed

Colour

Dog's Sex/Gender*

Female

Male

Animal Date of Birth

DD slash MM slash YYYY

Microchip No.*

You must enter a valid microchip number or registration of your animal will be delayed until microchip details are received and verified.

Proof of Microchip*

Please upload one of the following:
* Veterinary Surgeon’s Certificate
* Copy of the microchip certificate/paperwork

You can attach a picture of the document taken from your phone or camera.
IMPORTANT: Please ensure the image is large enough and legible. If an image is not suitable, we will need to request additional images.

Accepted file types: jpg, jpeg, png, gif, pdf, Max. file size: 2 MB.

Is the dog kept as a commercial security dog?*

Yes

No

Has the dog been declared a dangerous dog?*

Yes

No

If yes, please provide details*

Is the dog desexed or sterilised?*

Yes

No

Proof of sterilisation*
Please upload one of the following:
* Veterinary Surgeon’s Certificate
* Signed statutory declaration

You can attach a picture of the document taken from your phone or camera.
IMPORTANT: Please ensure the image is large enough and legible. If an image is not suitable, we will need to request additional images.
Accepted file types: jpg, jpeg, png, gif, pdf, Max. file size: 2 MB.

Photo of your pet*
To assist in identifying your pet should it be lost or stolen, please attach a clear and up to date photo of your pet.
IMPORTANT: Please ensure the image is large enough. If an image is not suitable, we will need to request additional images.
Accepted file types: jpg, jpeg, png, gif, pdf, Max. file size: 2 MB.

Renewal Period*
(Note: Dog registrations expire on the 31 October of each year. From 1 June of each year, half the normal fee will be applicable to FIRST annual registrations only)

1-year

3-year

Life

Owner Details (one owner only)

Owner Name*
Title First Surname

Date of Birth*
DD slash MM slash YYYY

Are you a pensioner or concession card holder?
Pensioner concessions can only be applied on the production of a current Pensioner Concession Card (issued by Centrelink or Department of Veteran Affairs), State Concession Card, or a Senior’s Card together with a Commonwealth Senior’s Health Card.
Yes

Pension / Concession Proof*
Please upload a photo of your pensioner / concession card. You can attach an picture of the card/document taken from your phone or camera.
IMPORTANT: Please ensure the image is large enough and legible. If an image is not suitable, we will need to request additional images.
Accepted file types: jpg, gif, png, pdf, Max. file size: 150 MB.

Mailing Address*
Street Address Address Line 2 Suburb State Post Code

Contact Phone*

Email*

Delegate Owner Details / Alternative Contact

Name*
Title First Surname

Date of Birth*
DD slash MM slash YYYY

Residential Address*
Street Address Address Line 2 Suburb State Post Code

Contact Phone*

Email

Payment Details

1-Year, Sterilised, Concession*

Price:

1-year Concession and Not Sterilised Fee*

Price:

1-year No Concession and Sterilised Fee*

Price:

1-year No Concession and Not Sterilised Fee*

Price:

1-year Dangerous Dog*

Price:

3-year Concession and Sterilised Fee*

Price:

3-year Concession and Not Sterilised Fee*

Price:

3-year No Concession and Sterilised Fee*

Price:

3-year No Concession and Not Sterilised Fee*

Price:

Life Concession and Sterilised Fee*

Price:

Life Concession and Not Sterilised Fee*

Price:

Life No Concession and Sterilised Fee*

Price:

Life No Concession and Not Sterilised Fee*

Price:

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payment_process_mode

NOTE: THE PAYMENT PROCESSING CONTROLS ON THIS FORM ARE CURRENTLY SET FOR TEST MODE
(Use either 5555444433331111 or 4444333322221111 for the Credit Card No. with 111 as the CCV)

Payment Type Code

Total (GST N/A)

This field is hidden when viewing the form

Payment Type

Credit Card*

MasterCard
Visa
Supported Credit Cards: MasterCard, Visa
Card Number
Expiration Date Month Year
Security Code Cardholder Name

Email
This field is for validation purposes and should be left unchanged.