Applicant details

Full name:

Company name (if applicable):

Are you the owner or occupier?

Owner Occupier Owner/Occupier

Date of birth:

Postal address:

Suburb/Town:

Postcode:

State:

Phone (work):

Phone (home):

Phone (mobile):

Email:

Firearms

If you are proposing to use firearms, provide your firearms licence details below.

Firearms licence number:

Expiry date:

Category:

If it is proposed that persons other than the landholder will harm kangaroos under this licence, the landholder must retain records of their names and firearms licence numbers and submit to NSW National Parks and Wildlife Service within 7 days of licence expiry.

Current method of control

Are you currently using non-lethal methods of control to reduce the problem?

YesNoExamples include: exclusion fencing, other exclusion methods, scare devices, gating, shelter, olfactory devices.

Non-lethal method(s) used

Length of time trialled

Result

Species to be controlled

List the species and estimated number of animals causing the problem:

Species (common name)

Eastern greyWestern greyRed

Estimated eastern grey number on property

Estimated western grey number on property

Estimated red number on property

Number eastern grey requested to be harmed

Number western grey requested to be harmed

Number red requested to be harmed

Previous licences

Have you previously held a Licence to harm kangaroos on this property?

Yes No

Have your property boundaries changed?

YesNo

Please provide a Local Land Services rates notice and a map of property location to verify property owner, size and address. Additional information may also be required by the officer assessing this application.

Upload documents

If yes, state your last Licence number:

Start date:

Expiry date:

Upload a copy of your record of return if you have not submitted them

If you have not submitted your record of return, these must be submitted within 7 days of the expiry of the licence.

Persons who have not submitted records of activities under previous licences may not be granted a new licence.

Declaration

For the purposes of the following questions, 'the applicant and associates' include the persons nominated to be authorised under this licence, any partner or other associate to these persons including relatives and friends, and any companies to which these persons have been a director or associated in the management of a corporation.

‘Technical competencies’ means the specific skills and knowledge required to keep animals listed on the NSW Native Animal Keepers' Species List 2016 healthy and maintained in accordance with your licence conditions (if granted).

Has the applicant and/or associates contravened any licence conditions, authority or law concerning the protection, conservation or management of animals or ecological communities?

YesNo

Explanation

Has the applicant and/or associates provided false or misleading information in connection with a matter under the Biodiversity Conservation Act 2016?

YesNo

Explanation

Has the applicant and/or associates been convicted of any fraud or dishonesty offences?

YesNo

Explanation

Has the applicant and/or associates the technical competencies to undertake the activities for which you are applying?

YesNo

Explanation - You must explain why you do not have the skills to undertake the activities for which you are applying

Signature

Date