Customer Request Management Entry

Instructions

To help us process your request in a timely manner, please complete with as much detail as you can.
Registered users can track their requests through the account summary in their profile.

You will receive an email confirmation of your request after 5.30pm on the day of your submission.
If you submit after 5.30pm your confirmation email will be sent at 5.30pm the following day.


Collection of Information & Privacy Statement
The information collected in this application form is being collected by Council for reference and identification purposes. We will only use personal information provided by you for the purposes for which it was collected and in order for Council to fulfil its business requirements.
In accordance with our Privacy Policy we will not disclose your personal information without consent to a third party, institution or authority except where required by law or other regulation.

Deceased or Departed Animal

Deceased or Departed Animal   

Customer Details (Required)

Customer Details (Required)

Name

Name
'

Contact Details

Contact Details
Residential address

Residential address

Postal address if different from residential

Postal address if different from residential

Contact By

Other Contacts Add

Name of Owner (as per registration, if not same as above)

Kept at Address (if not same as above)

Animal Name (Required)

Animal Breed (Required)

Tag Number (if known)

Animal Number (if known)

Status of Animal (Required)

Effective Date (DD/MM/YYYY) (Required)

New Address (if departed the area)

I do solemnly and sincereley declare that the listed information relates to a dog or cat owned by me and that the information supplied regarding the stated animal registration record is true and correct. (Required)

/eservice