PWL

Private Wildlife Licence Application Form

The minimum age for Applicants is 10 years (last birthday).

Applicants aged 10-17 years will require a supporting declaration by their Parent or Legal Guardian Applicants aged 10-17 years will require a supporting declaration by their Parent or Legal Guardian

Applicants aged 10-17 Years are not entitled to the concession rate unless they are an eligible person under the State Concessions Act 2004.

A Dingo Licence will only be issued to a natural person over 18 years of age.

Your Personal Details

First Name (required) *

Family Name (required) *

Other Given Names(s)

Your Residential Address

Address (required) *

Postcode (required) *

Please note: Only one person is allowed to hold an allowable combination of wildlife licences at the same time at any given premises. An application may not be granted if a wildlife licence already exists at this residential address.

Your Postal Address

Same as above

Please select type of Postal Address

PO BoxStreet Address

PO Box address

Street Address

Your Contact Details

Email (required) *

Phone (required) *

Date of Birth (required) *

Age last birthday (required) *

The applicant must be aged 10 years or over to proceed with this application.
Alternatively, a parent or legal guardian may wish to consider making an application in their own name.

Applicant is under 18 years: Parental permission is required to make this application

I, being the person named below as the parent or legal guardian of the Applicant, give my permission for the Applicant to:

make this application and topossess wildlife if a licence is granted.

Parent or legal guardian name (required) *

Phone (required) *

Email

Prior Convictions

Have you been convicted of any offence in Victoria under the Wildlife Act 1975 or the Prevention of Cruelty to Animals Act 1986 within the last 10 years? (required)

NoYes

Please give details (required) *

Licence Selection

Select Licence Type (required) *

This Licence authorises the holder to possess, keep, breed, buy, sell and dispose of any dingo for non-commercial purposes and to possess any dingo at other sites for the non commercial purposes of exercising, obedience training, education, or display at shows conducted by a canine association. A list of species allowed for this licence type is available at https://www.vic.gov.au/private-wildlife-licences).

This Licence authorises the holder to possess, keep, buy, sell and dispose of prepared or mounted specimens of any dead wildlife specified in the licence for non-commercial purposes. A list of species allowed for this licence type is available at https://www.vic.gov.au/private-wildlife-licences ).

This Licence authorises the holder to possess, keep, breed, buy, sell and dispose of any wildlife listed in Schedules 2 and 7 and specified in the licence for non-commercial purposes. A list of species allowed for this licence type is available at https://www.vic.gov.au/private-wildlife-licences ).

This Licence authorises the holder to possess, keep, breed, buy, sell and dispose of any wildlife listed in Schedules 2, 3 and 7 and specified in the licence for non-commercial purposes. A list of species allowed for this licence type is available at https://www.vic.gov.au/private-wildlife-licences ).

Prior to applying for and/or acquiring any dingo, an enclosure must be completed. An inspection of the enclosure will be organised with you prior to a decision being made on your application. Dingo enclosures must:

be child-proof and of sufficiently secure design and construction to prevent escape of dingoes and unauthorised access to dingoes.
have a minimum floor area of 30 metres² for up to two dingoes and an additional 10 metres² for each additional dingo (over 9 months).
have fences of either 3.0 metres in height or a minimum of 2.0 metres in height with an additional 45° degree inward return of at least 1.0 metre in length (or the inward return being a full secure roof).
have a 1.0 metre inward-facing mesh return fitted at the base of the fence and fastened to the ground at right angles to the fence or the fence is anchored securely to a cement slab.
have a secure escape-proof fence.

Please select your preferred licence term. Fees are indicative only as they will be calculated on a pro-rata basis from the date which an application is approved. If your application is successful a payment notice will be forwarded to you.

Please select Licence Term (required) *

One YearThree Years

Valid to 30 September 2024

Valid to 30 September 2026

Concession. Do you hold a valid Commonwealth Health Care Card?

YesNo

You must hold a current Concession card (shown below) and be an eligible person under the State Concessions Act 2004.

Please note: Seniors and Student Cards do not meet eligibility requirements for the concession rate. If you are claiming a concession rate, you may be asked to provide proof of eligibility. False or misleading information may result in the cancellation of your licence.

Maximum cost: If approved, your licence could cost up to:

Basic Licence
- one year

Basic Licence
- three year

Basic Licence - one year (concession)

Basic Licence - three year (concession)

Advanced Licence
- one year

Advanced Licence
- three year

Advanced Licence - one year (concession)

Advanced Licence - three year (concession)

Specimen Licence - three year

Specimen Licence - three year (concession)

Dingo Licence
- one year

Dingo Licence
- three year

Dingo Licence - one year (concession)

Dingo Licence - three year (concession)

Possession of Wildlife

Please list any wildlife currently in your possessionPlease leave blank if 'not applicable'.

Please provide permit numberPlease leave blank if 'not applicable'.

Do you currently have dingoes in your possession? If ‘yes’, please provide details below. Please attach a separate sheet if more space is required.

Animal name or microchip no.

Sex

Age

Collection, use and disclosure of personal information

Privacy and Data Protection Act 2014

The Department of Energy, Environment and Climate Action (DEECA) 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 DEECA or its contracted service providers under confidentiality agreements to survey you about your experience with DEECA or to seek feedback related to 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 DEECA by contacting the Customer Service Centre on 136 186.

Applicant's declaration

I understand that there are penalties for making a false declaration and that any licence issued as a result of a false declaration will be cancelled and may affect my eligibility to keep wildlife in the future and that all details provided by me on this form are true and correct. I also consent to the collection, use and disclosure of my personal information for the purposes described above. *

Signature

Draw signature|Type signatureClear

When submitted (click the 'Lodge my Application' button below) your application will be assessed within five business days.

OfficeUseOnly

BasicMultiplier

OneYearDenominator

ConcessionMultiplier

ThreeYearMultiplier

ThreeYearDenominator

OneYearMultiplier

AdvancedMultiplier

DingoMultiplier

FeeUnitValue

Save and Complete Later