ATCW

Application for an Authority to Control Wildlife

Personal details

First name *

Other given names

Family name *

Date of birth *

Residential address *

Postal address same as residential address

Postal address

Contact details

Phone - personal *

Email address *

Applicant’s relationship to the land with the wildlife problem

Please specify

Land where wildlife is to be controlled *

Private landCrown land

Name of park or reserve

Business name

Only complete if the land is owned under the name of a business

Description and location of land where you plan to control wildlife

Crown Allotment number *

Crown Allotment number(s)must be supplied. See your Rates Notice or Shire Office, or look for your Crown Allotment number at

https://www.propertyandlandtitles.vic.gov.au/property-information/property-information

or

https://www.landata.vic.gov.au/tpc_specify_property.aspx

Property address *

Municipality *

Approx area in hectares *

Land use zone *

Latitude and longitude coordinates

Use https://www.bing.com/maps/ to obtain lat/long coordinates.

When the map appears, navigate to the location and right-click the mouse. A popup will appear. At the bottom of this popup list you will be able to copy the coordinates to your clipboard. Paste the coordinates below.

Latitude and longitude coordinates

Species, wildlife impact, and control methods

If you are applying for an ATCW for an issue related to Eastern or Western Grey Kangaroos, have you registered for the Kangaroo Harvest Program or had an authorised harvester shoot kangaroos on your property? *

YesNo

Species to control - 1

Select species *

No. causing problem *

No. requested for control *

If you are experiencing severe and/or rapidly accelerating impact of dingoes on livestock, or there are human safety risks, please submit your application form and then email the Conservation Regulator at conservationregulator@delwp.vic.gov.au

Wildlife impact *

Description of impact *

Attempts made to reduce impact *

Add another species to control?

Species to control - 2

Select species *

No. causing problem *

No. requested for control *

If you are experiencing severe and/or rapidly accelerating impact of dingoes on livestock, or there are human safety risks, please submit your application form and then email the Conservation Regulator at conservationregulator@delwp.vic.gov.au

Wildlife impact *

Description of impact *

Attempts made to reduce impact *

Add another species to control?

Species to control - 3

Select species *

No. causing problem *

No. requested for control *

If you are experiencing severe and/or rapidly accelerating impact of dingoes on livestock, or there are human safety risks, please submit your application form and then email the Conservation Regulator at conservationregulator@delwp.vic.gov.au

Wildlife impact *

Description of impact *

Attempts made to reduce impact *

Submitting supporting evidence

Should you wish to provide evidence to support your application, please email the relevant regional team at the address listed below. You can find out which region you live in on our website https://www.deeca.vic.gov.au/communities-and-regions/regions-and-locations

In your email please clearly state your full name and address.

Port Phillip region:permissions.portphillipregion@delwp.vic.gov.au

Hume region:atcw.hume@delwp.vic.gov.au

Barwon South West region: barwonsouthwest.cr@delwp.vic.gov.au

Gippsland region: gippsland.cr@delwp.vic.gov.au

Grampians region: atcw.grampians@delwp.vic.gov.au

Loddon Mallee region: permissions.lm@delwp.vic.gov.au

INFORMATION PRIVACY

Privacy and Data Protection Act 2014

The Department of Environment, Land, Water and Planning (DELWP) is committed to protecting personal information provided by you in accordance with the principles of the Victorian privacy laws. The information you provide will be used to monitor compliance with licence conditions and to provide information about any changes to legislative requirements. Your contact details may also be used by DELWP or its contracted service providers under confidentiality agreements to survey you about your experience with DELWP or to seek feedback related the keeping of wildlife. A licence may not be issued if the information required is not provided.

The information you provide will also be made available to any authorised law enforcement agency.

You may access the information you have provided to DELWP by contacting the Customer Service Centre on 136 186.

As the applicant for this Authority to Control Wildlife, I agree that by submitting this form I acknowledge that it is an offence under Section 58B of the Wildlife Act 1975 to provide false or misleading information in, or in connection with, the application for an Authority to Control Wildlife and I state that the information that I have provided is true, correct and complete.