Application to register a dog(s)

For the year 1 July 20_ _ to 30 June 20_ _

(Under section 36, Dog Control Act 1996)

Registration transfer Replacement tag Renewal

/ /
/ /

Postcode:
Alternative contact number:
Tick to receive dog registration renewals by email
Address where dog is usually kept (if different from above):

SuperGold Community Services (CSC) combo card refer to information on the reverse of this form Responsible dog owner licence holder

Complete your dog(s) details

Dog details Dog one Dog two Dog three
Dog name
Breed Primary: Primary: Primary:
Secondary: Secondary: Secondary:
Age Years: Months: Years: Months: Years: Months:
Colour Primary: Primary: Primary:
Secondary: Secondary: Secondary:
Sex Male Female Male Female Male Female
Neutered No No No
Microchip number
Distinguishing marks

Tag preference Strap Strap Strap

Dog ref #
Office New tag #
use only
Fee
Receipt #

Declaration
I certify that I have read this form in its entirety and at the time of signing, the details included are, to the best of my knowledge,
true and correct. I understand that failure to supply information or giving false information may result in further action.

Signature of dog(s) owner: Date:

For office use only.

Total fees payable Dog one Dog two Dog three

Total fee $ $ $ $
 BC5601
Transfer details - Only complete if you are transferring your dog registration from outside of Auckland.
Dog one Dog two Dog three
Council currently registered with
Current tag number

Owner classifications
Please tick the appropriate box if any of the following classifications apply under the Dog Control Act 1996 (the Act).
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One or more of your dogs is classified as ‘menacing' Dog name(s): ............................................................................................................
A menacing dog is classified under section 33A or section 33C of the Act. A dangerous dog is classified under section 31 of the Act.

Payment options

Online You can pay by Visa, MasterCard or Account2Account (bank transfer). To register an account and pay online visit
To complete an online registration you will need to register an account. onlineservices.aucklandcouncil.govt.nz

In person Cash, cheque, Eftpos or credit card (MasterCard or Visa). Credit At any Auckland Council service centre.
card payments will incur a surcharge of 1.75% of your payment amount. To find your nearest customer service centre visit,
aucklandcouncil.govt.nz/contactus

Mail Cheque – Make cheques payable to Auckland Council. Dog Registration

Send with your signed and completed application form to: Auckland Council
Private Bag 92300
Auckland 1142

For more information about your payment and legal obligations as a dog owner, refer to the ‘Information relating to dog registration’
page, visit aucklandcouncil.govt.nz/dogs or phone 09 301 0101.

What you need to know

• The information requested in this form is needed to register your dog(s). You must notify Auckland Council of any change of address
or change in ownership of the dog(s).
• Your date of birth is required by the Act; it enables Auckland Council to distinguish you from other persons with the same name.
• If your dog is neutered please provide a copy of a veterinary certificate with application to receive the relevant discount.
• You will receive a tag once you have completed the application process and we have received your payment.

SuperGold Community Services (CSC) combo card

If you hold a SuperGold Community Services (CSC) combo card, please either (a) bring your CSC combo card, payment and
‘Application to register a dog(s)’ form to one of our service centres or (b) post your ‘Application to register a dog(s)’ form and payment,
including a photocopy of both sides of your signed SuperGold CSC combo card. (Please do not post your actual card).
Important privacy information
Your information is required under the Act to register your dog(s). Failure to provide the requested information will result in your dog not
being registered, which is an offence under the Act. Section 35 of the Act allows any person to apply in writing for the name and address
of the owner of any specified dog. Auckland Council is required to provide that information where it is satisfied of that person’s identity
and that the information is required for one of a limited number of purposes specified in section 35(5), such as returning a lost dog to its
owner or seeking compensation for damage.
The personal information that you provide in this form will be held and protected by Auckland Council in accordance with our privacy
policy (available at aucklandcouncil.govt.nz/privacy and at Auckland Council libraries and service centres) and with the Privacy Act 1993.
Auckland Council's privacy policy explains how we may use and share your personal information in relation to any interaction you have
with the council, and how you can access and correct that information. We recommend you familiarise yourself with this policy.

Your receipt Dog name Dog reference New Strap/Disc #

(For office use only)
Please do not separate. Return both portions. Office
stamp here
Receipt number (office use only)