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21:43:01

Animal registration – new application for cat

Application for Cat 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 9(2)(e) of the Cat Act 2011, 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.

Cat's Details

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

Total number of cats that are kept at these premises (not including this one)?*

Please enter a number from 0 to 99.

Animal Detail*

Animal Name

Breed

Colour

Cat's Sex/Gender*

Female

Male

Age of animal*

Years

Months

Animal Date of Birth

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.

Is your animal exempt from microchipping?
Some cats may be exempt from microchipping due to old age or ill health that would prove detrimental to the cat.
Yes

Microchipping Exemption Proof*
Proof of microchip exemption must be provided by a veterinarian and attached below. You can attach an 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.

Microchip Number*
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 an 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.

Where did you adopt your cat from?*

Breeder

Organisation e.g. Cat Haven, Cat Rescue, RSPCA etc

Person

Name*
Please provide as much name detail of the breeder, organisation or person from where the cat was adopted.
Name (Breeder/Organisation/Person)

Address of Breeder/Organisation/Person*
Address Line 1 Address Line 2 Suburb State Post Code Country

Contact Phone*
Please supply a contact phone number for the Breeder/Organisation/Person from which the cat was adopted.

Renewal period required*
(Note: Cat registrations expire on the 31 October of each year. From 1 June until 30 September 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

Owner's date of birth*
Owner must be over 18 years of age
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, jpeg, png, gif, pdf, Max. file size: 150 MB.

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

Phone*
A contact phone number is required.

Other Phone
Additional contact number (optional)

Email*

Alternative Contact Details

Under existing WA legislation, alternative contact details are required in case we are unable to contact you e.g. your cat is found or impounded, registration details etc

Name*
Title First Surname

Date of Birth
MM slash DD slash YYYY

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

Phone*
A contact phone number is required.

Other Phone

Email

Payment Details

1 year Concession and Sterilised Fee*
A reduced fee applies to new registrations between 1 June until 23 September of each year. All other times the full fee will be $10.00 for 1-Year registrations.

Price:

1 year Non Concession and Sterilised Fee*
A reduced fee applies to new registrations between 1 June until 23 September of each year. All other times the full fee will be $20.00 for 1-Year registrations.

Price:

3 year Concession and Sterilised Fee*

Price:

3 year Non Concession and Sterilised Fee*

Price:

Life Concession and Sterilised Fee*

Price:

Life Non Concession and 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

This field is hidden when viewing the form

Payment Type

Total (GST N/A)

Credit Card

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

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