Application Form - Licence to keep an Animal Boarding Establishment

Name/s of Applicant/s

Title ^*

First Name

Surname ^*

Address of Premises ^*

Address of Premises

Postcode ^*

Telephone Number

E-mail Address

Type of Premises ^*

The maximum number of animals to be kept at any one time:

Dogs

Cats

I enclose a remittance of £102.50 for the licence fee (Cheques and Postal Orders to be made payable to North East Lincolnshire Council)

Signed 1	DatedDay	Signed 2	DatedDay
Signed 1	DatedMonthYear	Signed 2	DatedMonthYear

Please use the submit button to generate the PDF printed form. Sign the form and return together with said fee to the following address;

Environmental Services, Freeman House, Freeman Way, Grimsby, North East Lincolnshire, DN32 7AU

For any queries please telephone (01472) 324770

DATA PROTECTION NOTICE
North East Lincolnshire Council is a Data Controller for the purposes of the Data Protection Act 1998. Any personal information supplied on this form will be processed in accordance with the principles of the Act. If you want to find out more about your rights under the Act, you can contact the Office of the Information Commissioner (tel: 01625 545 700 / http://www.dataprotection.gov.uk) or the Director of Law and Democratic Services on 01472 313131.



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