Animal Registration Form

Animal Registration Application Form

All dogs and cats must be registered with the City of Whittlesea from 3 months of age. Animal registration fees are effective from April 10 to April 9 in the following year.

Fields marked * must be completed.

Owner’sdetails
Surname*
Given name*
Phone* (please provide at least one phone number)
Business phone
Mobile phone
Street address*
Suburb and postcode*
Will the animal be kept at the same address as above?* / Yes No
If no, provide address where animal will be kept
Animal details
Animal name*
Animal type* / Dog Cat
Animal gender* / Male Female
Age* / years and months
Breed(s)*
Main colour*
Other colour
Microchipping details (must be completed)
Microchip number*
Note: State law prevents us from registering an animal that has not been microchipped. This includes animals transferring from another Council. / Please submit your microchipping certificate with this application
Office Use Only / Date received:
Received by: / Animal number:
Tag number:
Receipt number:
Dangerous, menacing and restricted breed dogs
Is the animal a restricted breed dog?*
The Domestic Animals Act 1994 requires that all persons applying to register a dog must identify whether or not the dog is a ‘restricted breed’. Dogs of the following breeds are ‘restricted breeds’ – American Pit Bull Terrier or Pit Bull Terrier, Dogo Argentino, Fila Brasilerio, Japanese Tosa and Perro De Pressa Canario or Presa Canario. / Yes No
Has this dog ever been declareddangerous by any Council?* / Yes No
Is this a guard dog (i.e. guards a non-residential premise)?* / Yes No
If a guard dog, is it trained to attack or bite? / Yes No
Has this dog ever been declared menacing by any Council?* / Yes No
Reduced fee registration
To receive a reduced animal registration fee, your pet must meet any of the following criteria and you must attach relevant supporting documents:
Is the animal desexed?* / Yes No
Is the animal over 10 years old?* / Yes No
Is the animal kept for working stock or breeding as part of a registered business?* / Yes No
Does the dog have an obedience training certificate recognised by the Australian National Kennel Control?* / Yes No
Do you hold a full pension concession card?*
Note: Health Care Cards are not accepted / Yes No Pension number:
Do you have a current membership with any of the following organisations:*

• Dogs Victoria
• Feline Control Council
• Cat Authority of Victoria
• Governing Council of the Cat Fancy Australia
• Waratah National Cat Alliance

/ Yes No
Registration fees

Cat registration fees

Fee type / Normal rate / Pension rate
Valid April 2017 – April 2018
Standard (not de-sexed) / $82 / $42
Reduced / $23 / $13

Note: All cat registration fees above include State Government Levy of $2.

Dog registration fees

Fee type / Normal rate / Pension rate
Valid April 2017 – April 2018
Dangerous/menacing / $265 / $265
Guard/Protective Services / $142 / $142
Standard (not de-sexed) / $142 / $75
Reduced / $45 / $22

Note: All dog registration fees above include State Government Levy of $3.50.

Payment details
Is your dog a Guide Dog, Customs Dog or Greyhound registered with Greyhound Racing Victoria?* / Yes, no payment is required
No, please pay relevant registration fee
Are you transferring this animal from another council where it is currently registered?* / Yes, no payment is required
No, please pay relevant registration fee
Payment options / Cash or EFT (in person only)
Cheque/money order
Credit card (complete authorisation form on last page)
Registration declaration
I declare that all information provided by me is true and correct.*
I understand that provisions of the Domestic Animals Act 1994 make it an offence to provide false, willfully inaccurate or misleading information in or in regard to an Animal Registration Form and/or Declaration, and that such offences may make me liable to a penalty not exceeding $500 or a Court prosecution. I declare that all information stated and supplied within this application is true and correct. / Date:
Yes No
Note:For the purpose of the Domestic Animals Act 1994, where the ‘owner’ is under the age of 17 years, a parent or guardian is deemed to be the owner.
Checklist
Please ensure your application is complete and you provide the required supporting documents and fee (if applicable)
Failure to supply all required documentation will delay processing of your application, and your animal will remain unregistered during this time. / Microchipping (number and documentation)
Desexing (sterilization certificate)
Pensioner status (copy both sides of card)
Transfer to City of Whittlesea (proof of current registration payment with previous Council)
Relevant fee (if applicable)
If you cannot provide evidence that your animal is: over 10 years old ,desexed,obedience trainedor a current member of the VCA/FCC/GCCF/DCC , you must complete this Statutory Declaration:
I, of
In the State of Victoria do solemnly and sincerely declare that my animal meets the criteria as indicated above. I make this solemn declaration conscientiously believing the same to be true and by virtue of the provision of the Act of Parliament of Victoria, rendering a person making false declaration punishable for willful and corrupt perjury.
Declared at: in the State of Victoria, this day of 20
Signature of Owner
Before me of
Signature of Witness
The authorised witness must print or stamp his or her name, address and title under Section 107A of the Evidence Act 1958 (Victoria).(e.g. Justice of the Peace, Pharmacist, Police Officer, etc.)
(e.g. Justice of the Peace, Pharmacist, Police Officer, Court Registrar, Bank Manager, Medical Practitioner or Dentist)
How to submit your application

• MailLocalLaws, City of Whittlesea, Locked Bag 1, Bundoora MDC, 3083
• In personCouncil Offices - 25 Ferres Boulevard, South Morang

After you apply for registration
We will process your application within 5 business days and mail you a registration tag that your pet must wear at all times. If we have any questions about your application, we’ll contact you.

CreditCard PaymentAuthorisation

MailLockedBag1,BundooraMDC3083

Offices,25FerresBlvd,SouthMorang VIC 3752

Card type Visa Mastercard

Cardnumber///

Expirydate (MM/YY)/

Cardholdername

Paymentamount$

IauthoriseCityofWhittleseatochargetheamountstatedabove.

Cardholder signature

Date//