Private individual account request form

Name of applicant

First name

Middle name(s)

Last name

Place of residence (you must provide your full address, failing to do so will mean a cancellation of your supply number)

I cannot find my address and will input my address manually

This must be a street address, post office boxes are not permitted.

Unit No

Address

lga suburb text

lga suburb postcode

Suburb (must be selected)

State

Contact details

Email . sort ascending

At least 1 phone number is required

Mobile phone

Mobile number must be entered in the following format: 0412345678

Home Phone

Telephone number must be entered in the following format: 0731234567

Preferred contact method

Applicant declaration and privacy statement

Your personal information (including name, contact number and email address) is being collected by the Department of Agriculture and Fisheries (the Department) to provide you with the services you request through this Account. Your personal information will not be provided to other third parties without your consent, unless authorised or required by law. Further information about the Department’s commitment to privacy is available from our website: https://www.daf.qld.gov.au/website-information/privacy.

I understand all correspondence regarding my registration will be sent to me via Email

I have read and understood my responsibilities under the Animal Management(Cats & Dogs) Act 2008 and Animal Care and Protection Act 2001(legislation.qld.gov.au) and the Queensland Animal Welfare Standards and Guidelines for Breeding Dogs and their Progeny - Queensland Animal Welfare Standards and Guidelines for Breeding Dogs and their Progeny - Queensland Dog Breeder Register - Factsheets | Publications | Queensland Government

Please note the Queensland Government dog breeder registration does not exempt you from the need to comply with other local government requirements regarding registering and keeping of dogs within their local area.

I have checked with my Local government to ensure I am complying with the relevant Local Laws and Planning scheme requirements. Local Government Directory (dlgrma.qld.gov.au)