Form D Part 1: Application for a permit to exhibit a ...



|[pic] |Form E Part 1 – Application for a variation to an authority – Addition of a new |

| |species to an Approval to Exhibit Animals at Mobile Establishments |

| | |

This form can be used to apply to have a new non-prescribed species added to an Approval to Exhibit Animals at Mobile Establishments. Only non-prescribed species can be added using this form.

To apply for a Permit to exhibit prescribed species use a Form D: Application for a Permit to Exhibit Prescribed Species. Prescribed species are listed in Schedule 2 of the Exhibited Animals Protection Regulation 2010.

1. Applicant details

|Applicant name |      |

|Trading name |      |

|Approval number |      |

2. Species

A separate application form should be submitted for each species to be added to the Approval.

Note: Only non-prescribed species can be added using this form. Use Form D to apply to exhibit an animal of a prescribed species. Prescribed species are listed in Schedule 2 of the Exhibited Animals Protection Regulation 2010.

|Common name of species |Scientific name of species |Numbers |

| | |M |F |U |Total |

|      |      |     |     |     |     |

It is important to note that the possession of the same species under both an Exhibited Animals Protection Act 1986 authority and a Biodiversity Conservation Act 2016 licence will not be approved.

3. Size of Establishment

Is the applicant currently a minor exhibitor authorised to display or hold for display 30 animals or less?

YES NO

Will the acquisition of this species raise the total holdings to more than 30 animals?

YES NO

4. Supporting documents

To support your application, attach the following:

|Attachment |Supporting document details |

|A |Expertise and experience of the applicant, or staff of the applicant’s organisation, with the keeping of this or |

| |similar species. |

| |(Mark as Attachment A) |

|B |Housing and facilities details |

| |If new construction is proposed at any associated off-display establishment – attach a completed application (Form G |

| |Application for Approval for Construction or Alteration at a Fixed or Off-display Establishment) with the relevant |

| |fee. |

| |If new transport facilities or display enclosures are proposed: |

| |For each container to be used to transport animals you should attach (Mark as Attachment B1) diagrams which clearly |

| |show: |

| |a plan view of the transport container (from the “top”); |

| |an elevation view of the transport container (from the “front”); |

| |a cross section view of the transport container (a “slice” through the middle). |

| | |

| |The attached diagrams should include the following information where applicable: |

| |the species which the transport container is to hold; |

| |the scale of the plan (e.g. 10cm = 1m); |

| |details of the materials to be used and the construction followed; |

| |details of additional furnishing in containers, such as bags within boxes. |

| | |

| |2. For each vehicle to be used to transport animals you should attach a document (Mark as Attachment B2) containing |

| |the following information: |

| |a description of the vehicle; |

| |the location of each transport container within the vehicle; |

| |a description of how each transport container will be fastened within the vehicle; |

| |a description of ventilation that will be provided to the animals within the vehicle; and |

| |how the animals will be monitored during their transport in the vehicle; |

| |a description of the barrier between the animal transport containers and the driver’s compartment. (This barrier must |

| |be strong enough to hold the weight of animals and their containers in the event of an accident.) |

| | |

| |3. Provide details of the housing to be utilised for each specimen in the event that animals will be away from the |

| |off-display establishment overnight. (Mark as Attachment B3) |

| | |

| |4. If display enclosures or pits are to be used, you should attach diagrams (Mark as Attachment B4) for each enclosure|

| |which clearly show: |

| |a plan view of the display enclosure (from the “top”); |

| |an elevation view of the display enclosure (from the “front”); and |

| |a cross section view of the display enclosure (a “slice” through the middle); |

| |the dimensions (length, width, height) of the display enclosure. |

| | |

| |The attached diagrams should include the following information where applicable: |

| |the species which the display enclosure is to contain; |

| |the number of animals to be displayed within the display enclosure; |

| |details of furnishing to be used within display enclosures and how they will be landscaped to provide a naturalistic |

| |setting which resembles the animal's habitat. |

| |If existing housing, transport facilities or display enclosures are to be used - indicate the species previously |

| |approved for the enclosure and provide diagram(s) indicating size and furniture and photographs which show the key |

| |features of the enclosure. (Mark as Attachment B) |

|C |Describe the planned method of transport for the species |

| |(Mark as Attachment C) |

|D |A diet sheet detailing the content and frequency of the diet to be fed to this species. |

| |(Mark as Attachment D) |

|E |A photocopy of the front page of all relevant exhibit standards. |

| |(Mark as Attachment E) |

|F |Wording that will appear on the identification sign for this species and/or key educational message to be delivered in|

| |presentations by mobile exnibitor. |

| |(Mark as Attachment F) |

5. Declaration

I have read and understood the relevant standards and undertake to exhibit the animals in accordance with those standards.

I consent to staff of the NSW Department of Primary Industries contacting any referee, person or organisation referred to in this application as part of the assessment process.

I certify that I will not hold animals of the same species under both an Exhibited Animals Protection Act 1986 authority and a licence issued under the Biodiversity Conservation Act 2016.

|Name |      |

|Position Title |      |

|Signature | |

|Date |      |

6. Fees

The lodgement fee is $23 per application.

Select payment method:

|Cheque | |Money order | |Credit Card | |

|(Payable to NSW Department of | |(Payable to NSW Department of | |(see below) | |

|Primary Industries) | |Primary Industries) | | | |

|Payment amount |      |

|Type of card |Visa Mastercard |

|Card no. (16 digits) |  |  |  |  |  |

|Expiry |  |  |  |  | |

|Cardholder’s name |      |

|Cardholder’s Signature | |

Any application that is not accompanied by the relevant fee(s) and supporting documents referred to in this form will be returned without further assessment.

Submit the completed form:

Either by

• the preferred method: emailing a pdf file of the completed, signed form, attachments and credit card details to exhibited.animals@dpi..au

or

• posting the completed, signed form and attachments, including lodgement fee, to:

Exhibited Animals

Biosecurity and Food Safety Compliance

The Department of Primary Industries

Locked Bag 21

ORANGE NSW 2800

For more information or for assistance completing the form, contact the Exhibited Animal Licensing Unit on 02 6552 3000.

Privacy: The information collected in this form will be stored securely and used only for the purposes for which it has been collected. See our full privacy policy at

Please keep a copy of this application for your records.

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