Dog owners should complete this form to advise the Council of their dog's death and to enable the Council where appropriate to make a partial refund of registration fees to a bank account.

Owner details

Please enter n/a if you don't have a middle name.

  

Refund details

A portion of the registration fees may be refunded to the registered owner of the dog.

Refunds are only able to be made by payment to a bank account and are a portion of the registration fee paid based on how much of the registration year is remaining.

Please note: The fee is calculated from the date the request is received by Council, not from the date the dog has passed away. This is in reference to Section 39 (2) of the Dog Control Act 1996.

Please provide bank account details.

  

Dog details

 

Note: It is an offence to make a false statement relating to dog registration.

Statement for the Purpose of Principle 3 of the Privacy Act

  1. The information is being collected to enable the Council to maintain its dog register and records
  2. The intended user of the information is the Council's Environmental Services Unit
  3. You have the right of access to and correction of any personal information held about you by the Council
  4. This information is held on the Council's dog register
  5. Supply of information from the dog register is strictly limited by Section 35 of the Dog Control Act 1996.