Application to microchip dog

Pursuant to the Dog Control Act 1996, Section 36A

Owner details

Full name

Date of birth

Residential address

Postal address

If different from residential

Email

Contact phone number

Dog details 1

Dog name

Breed

Colour

Dog registration year

Dog registration tag number

Dog details 2

Dog name

Breed

Colour

Dog registration year

Dog registration tag number

Dog details 3

Dog name

Breed

Colour

Dog registration year

Dog registration tag number

DECLARATION: I hereby confirm that the above information relating to the dog(s) in my care is correct, and that I do not own, nor have in my possession, any unregistered dogs over the age of three months

Agree

Application to microchip dog

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