Title Mr Mrs Miss * Forename * Surname * Address1 * Address2 Address3 Postcode * Telephone * Email *

2.Description of Dog

Colour of Dog * Breed of Dog * Sex of Dog Male Female * Age of Dog * Distinguishing Marks (if any) Name of Dog (if any) Kennel Club or Other Registration Number

Current Tag Number


Terms and conditions I declare that the information given above is correct in every respect and that I am not under 16 years of age and that I have not been disqualified from keeping a dog under the Welfare of Animals Act (Northern Ireland) 1972(a).
I agree with the terms and conditions  
Are you applying for an abatement of dog license fee only*    Yes No I further declare that I have attained the age of 65, that I live alone, that I normally keep the dog described above in my possession and that I have not previously been granted an abatement of licence fee in respect of any dog in the past 12 months
I agree with this declaration