<p> ANIMAL BOARDING ESTABLISHMENTS ACT 1963 APPLICATION FOR LICENCE TO KEEP A HOME BOARDING ESTABLISHMENT FOR DOGS/CATS</p><p>To: Gateshead Council</p><p>Name: Miss / Ms / Mrs / Mr / Other: Address:</p><p>Name of Company: Postcode: Date of Birth: Telephone Numbers: Email: as (proposed) occupier(s) of the premises hereinafter mentioned HEREBY MAKE APPLICATION in pursuance of Section 1 of the Animal Boarding Establishments Act 1963 for a LICENCE TO KEEP AN ANIMAL BOARDING ESTABLISHMENT at the premises of which particulars are given below.</p><p>Please enclose payment with the application form. The application will not be processed until the appropriate fee has been paid. 1 (a) Are you disqualified under the act from keeping a boarding establishment for animals? or (b) under the Pet Animals Act 1951 from keeping a pet shop; or (c) under the Protection of Animals (Cruelty to Dogs) Act 1933, from keeping a dog; or (d) under the Protection of Animals (Cruelty to Dogs) (Scotland) Act 1934, from keeping a dog; or (e) under the Protection of Animals (Amendment) Act 1954 from having custody of Animals; or (f) any offence under any of sections 4, 5, 6(1) And (2), 7 to 9 and 11 of the Animal Welfare Act 2006 2 Number of dogs/cats to be boarded on the premises:</p><p>3 Exercise and garden facilities including fencing:</p><p>4 Heating arrangements:</p><p>5 Method of ventilation of premises: 6 Lighting arrangements:</p><p>7 Water supply:</p><p>8 Arrangement for food storage:</p><p>9 Arrangements for disposal of excreta:</p><p>10 Description of isolation facilities for the control of infectious disease:</p><p>11 What provision has been made to deal with fire or other emergencies?</p><p>12 Has the Fire Officer been consulted regarding fire precautions?</p><p>13 Is an adequate register kept of all animals?</p><p>14 Name and address of Veterinary Practitioner:</p><p>Please ensure that the information requested in the above boxes is completed as comprehensively as possible, as incomplete application forms may have to be returned.</p><p>I/WE DO HEREBY CERTIFY that to the best of my/our knowledge and belief, the above particulars are true.</p><p>(Signed) ………………………………………………</p><p>*……………………………………………………… Date: ………………………...... </p><p>NOTE * Capacity, if Applicant signs on behalf of a Company or Partnership</p>