Wildlife Conservation Regulations 1970 Regulation 12 (AV / AL)

Application for an Avicultural (Avian) Keeper Licence Licence covers the keeping of avian fauna at the address stated on the licence.

Completed forms should be returned to: Further information on the licensing requirements is Dept of Biodiversity, Conservation and Attractions available from: 17 Dick Perry Avenue, Kensington or post to: Wildlife Licensing Section Locked Bag 30, Bentley Delivery Centre WA 6983 Phone: (08) 9219 9835 Or faxed to (08) 9219 8242 or emailed. Email: [email protected] AVICULTURE LICENCES ARE ISSUED FOR A 1-YEAR PERIOD, WITH FEES PAYABLE AS BELOW. PLEASE ALLOW FIVE (5) WORKING DAYS TO PROCESS COMPLETE AND CORRECT APPLICATIONS. Applicant

Surname Other names Dr/Mr/Mrs/Miss/Ms

Address (residential)

Postcode

Address (postal)

Postcode

Aviary Address

Postcode

Phone Fax Email

Mobile Date of birth

Signature Date of application

Applicant is required to provide: 1 proof of identity and age (driver’s licence, passport, or other appropriate document). 2 copy of Senior’s Card discount eligibility must be provided once. With no copy of card presented FULL fee must be paid. 3 details of any relevant convictions in Australia in the past five (5) years. Relevant conviction means a wildlife related offence.

FEES and PAYMENT: Licence Type (tick one only) Avicultural Licence (1 year)  Fee $10  Senior’s Fee $5 enclosed Advanced Avicultural Licence (1 year)  Fee $30  Senior’s Fee $15 enclosed

Payment Type

 CASH (enclosed)  CHEQUE / MONEY ORDER (enclosed)  CREDIT CARD (details below) Money order/cheques made payable to Department of Biodiversity, Conservation and Attractions (“DBCA”) to be attached to completed application form.

*Any details below will be detached and destroyed once payment is processed. Please print clearly ------

VISA / MASTERCARD PAYMENT Name of Cardholder: ______Signature: ______Amount: $ ______

Card No: ______Expiry Date: ____/______

Application for an Avicultural (Avian) Keeper Licence

EXEMPT FROM LICENSING No licence required if these are the only birds you hold Budgerygah (Budgie) Diamond Dove Banded (Double-bar) Finch Cockatiel or Weero Peaceful Dove Long-tailed (Blackheart) Finch Chestnut-breasted Mannikin Star Finch King Quail Zebra Finch

Please indicate the number of each species held. Only list birds currently held. Please do not include intended acquisitions.

AVICULTURAL No licence required to keep or dispose if you hold a total of less than 10 of these birds Avicultural Licence required if you hold a total of 10 or more of these birds No. No. No. Bourke’s Parrot Scarlet-Chested Parrot Masked Finch Turquoise Parrot Pictorella Mannikin

AVICULTURAL No licence required to keep or dispose if you hold a total of less than 4 of these birds Avicultural Licence required if you hold a total of 4 or more of these birds No. No. No. Sulphur-crested Cockatoo Long-Billed Corella (Central West) Western Rosella Galah Long-Billed Corella (Eastern) Red-capped Parrot (WA King) Little Corella Port Lincoln Ringneck (incl. 28)

AVICULTURAL Avicultural Licence required if you hold any number of the birds in this box (Also covers any birds in sections above) No. No. No. Stubble Quail Musk Lorikeet Hooded Parrot Brown Quail Little Lorikeet Mulga Parrot Red-Backed Button-quail Alexandra’s (Princess) Parrot Red-rumped Parrot Red-chested Button-quail Regent (Smoker) Parrot Red-vented Blue Bonnet Painted Button-quail Superb Parrot (Barraband) Yellow-vented Blue Bonnet Little Button-quail Red-winged Parrot Plum-headed Finch Bar-shouldered Dove Australian (Eastern) King Parrot Diamond Firetail Green-winged Pigeon Mallee Ringneck Painted Firetail Common Bronzewing Blue-winged Parrot Red-browed Firetail Crested Pigeon Elegant Parrot Gouldian Finch Squatter Pigeon Adelaide Rosella Blue-faced Finch Partridge Pigeon Pale-headed Rosella Yellow-rumped Mannikin Scaly-breasted Lorikeet Crimson Rosella Crimson Finch Rainbow Lorikeet Eastern Rosella Black-throated Finch (Parsons) Red-collared Lorikeet Yellow Rosella

ADVANCED Advanced Avicultural Licence required if you hold any number of the birds listed below AVICULTURAL (Also covers any birds in sections above) No. No. No. Spinifex (Red-plumed) Pigeon Yellow-tailed Black Cockatoo Green Rosella Brush Bronzewing Red-tailed Black Cockatoo Northern Rosella Major Mitchell (Pink) Cockatoo Eclectus Parrot Cloncurry parrot Gang-gang Cockatoo Purple-crowned Lorikeet Naretha (Little) Blue Bonnet Baudin’s Black Cockatoo Varied Lorikeet Golden-shouldered Parrot Carnaby’s Black Cockatoo Swift Parrot Rock Parrot

OTHER AUSTRALIAN BIRDS – Held but not included in any of the above lists No. No. Exotic birds No. European Goldfinch Java Sparrow

 PERMIT TO KEEP RESTRICTED BIRDS ALSO REQUIRED FOR THESE TWO (2) SPECIES