Application To Register A Dog
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1
2Application to register a dog(s)
For the year 1 July 2016 - 30 June 2017
(Under section 36, Dog Control Act 1996)
Step 1:
This application is for a:
New registration
Registration transfer
Replacement tag
Renewal
Step 2:
Complete your owner details
Full name:
Owner date of birth:
/
/
Second owner full name
:
Second owner date of birth:
/
/
(if applicable)
Address:
Postcode:
Home ph:
Mobile:
Business ph:
Email:
Address where dog is usually kept
:
(if different from above)
SuperGold Community Services (CSC) combo card
Current Responsible dog owner licence holder
Refer to information on the reverse of this form
Step 3: Complete your dog(s) details
Particulars of dog
Dog one – details
Dog two – details
Dog three – details
Dog name
Dog reference
Breed
Primary:
Primary:
Primary:
Secondary:
Secondary:
Secondary:
Age
Years:
Months:
Years:
Months:
Years:
Months:
Colour
Primary:
Primary:
Primary:
Secondary:
Secondary:
Secondary:
Sex
Male
Female
Male
Female
Male
Female
Neutered
Yes
No
Yes
No
Yes
No
Microchip number
Distinguishing marks/
tattoo
Registration class
Tag preference (please tick)
Disc
Strap
Disc
Strap
Disc
Strap
Step 4: Transfer details
(if you are not transferring a dog registration go to step 5)
If you are transferring your dog registration from a council outside of Auckland, please complete the fields below.
Council currently registered with
Current tag number
For office use only.
New tag number:
Dog one
Dog two
Dog three
Fee:
Dog one $
Dog two $
Dog three $
Receipt number:
Please do not separate. Return both portions.
Total fees payable
Dog one
Dog two
Dog three
(GST inclusive) See payment options on the reverse of this form
Total fee $
$
$
$
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