Report by licensee of action taken under licence to kill or take (non-Piscivorous) birds

Wildlife and Countryside Act 1981 (as amended)

Licence Number: xxxxxxx

Return by xxxxxxxxx

  • The provisions of the Environmental Information Regulations 2004 affect the information on this report.
  • The information requested in this form captures personal data about you – for example, your name and address. Your personal data will be managed and used by the Natural Resources Wales in accordance with the Data Protection Act 1998.

Name of licensee
Address of licensee / Postcode:
  1. The licence granted to you on (date) ___, for the killing or taking of Non-Piscivorous Birds requires that you provide Natural Resources Waleswith a report of action taken.
  1. All licensees must send this report to arrive not later than the 14th day after licence expires. Failure to do this could lead to the licence being revoked and/or to a subsequent licence being refused.

Please complete Section 3-9 below and sign Section 10

  1. Type of action taken: Tick as appropriate

(a)Alphachloralose to take pigeons…………………………………………………………………………………...

(b)Alphachloralose to take house Sparrows…………………………………………………………………………

(c)Alphachloralose-seconal to take pigeons…………………………………………………………………………

(d)Mist nets to take house sparrow……………………………………………………………………………………

(e)Carbon Dioxide to kill “pest” birds………………………………………………………………………………….

If Carbon dioxide was used,

Please specify the target species

(f)Other (e.g. the use of cage traps etc)………………………………………………………………………….….

If ‘Other’ please specify: type of

action

Target species

  1. Full address of site where action was taken
  1. Description of the site

(e.g. food warehouse,

Fruit farm, etc.)

  1. Area within the site

Whereaction was

taken (e.g. canteen,

grain store, Orchard,

etc.)

  1. Action Taken:

Date(s)
action Taken / Species / No. of birds killed/taken (if any)

If necessary, please continue on a separate sheet and tick here to indicate that you have done so

  1. Comments (e.g. reason why any

target species were not caught

under the provisions of this

licence, any hazards to other

wildlife etc.)

  1. For stupefying bait operation only:

(a)Number of day’s(b)Quantity of stupefying

Pre-baitingbait used

(c)Concentration of Alphachloralose or Alphachloralose-seconal mixture in bait

  1. Declaration

I declare that the particulars given in Section 3 above are correct to the best of my knowledge and belief.

Licensee's signature / Date
Licensee's name in BLOCK LETTERS

Please return this completed form to

Species Protection Team,

Natural Resources Wales,

Maes y Ffynnon,

Penrhosgarnedd,

Bangor,

LL57 2DW