Western Australian Current Regulations

ANIMAL WELFARE (SCIENTIFIC PURPOSES) REGULATIONS 2003 - SCHEDULE 1

Form 1

[r. 4, 7]

Animal Welfare Act 2002

Application for licence to use/supply animals for scientific purposes

Person or Scientific Establishment (Applicant)	Name:         ..............................................................................................
	Address:         ...........................................................................................         ...........................................................................................         ...........................................................................................         ...........................................................................................
Type of licence that is required	ο         Licence to use animals for scientific purposes
	ο         Issue	ο         Renewal
	ο         Licence to supply animals for scientific purposes
	ο         Issue	ο         Renewal
If applying for a USE licence, indicate the PRIMARY activity for which the animals are to be used	ο         Medical Research ο         Agricultural Research ο         Teaching ο         Other (please specify)		ο         Academic Research ο         Field Trials ο         Veterinary Research (including Wildlife)
Place(s) where animals are to be located under this licence	............................................................................................................ ............................................................................................................ ............................................................................................................ ............................................................................................................ ............................................................................................................

Animal ethics committee ( for USE licence only )	The applicant has — ο         established its own committee; or ο         arranged for the committee of         ............................................................................................         to act as its committee.

Experience and competence of applicant and staff	(Complete for a Use or a Supply licence ) ❑         The applicant and the applicant’s staff are experienced and competent in caring for and handling animals of the kind to be used or supplied. (Complete for a Use licence only) ❑         The applicant and the applicant’s staff are experienced and competent in using animals for scientific purposes. The following details are in support of the above statement(s): ............................................................................................................... ............................................................................................................... ............................................................................................................... ............................................................................................................... ............................................................................................................... ............................................................................................................... ............................................................................................................... ............................................................................................................... ............................................................................................................... ............................................................................................................... ............................................................................................................... ...............................................................................................................
Prior offences and related matters	Has the applicant or (to the best of the applicant’s knowledge) have any of its staff or students been convicted of an offence under this Act (or the Prevention of Cruelty to Animals Act 1920 ) or any equivalent legislation in another Australian jurisdiction, in the previous 3 years? ο No         ο Yes. Give details: ............................................................................................................... ............................................................................................................... Has the applicant —               •         ever had a licence under this Act or the Prevention of Cruelty to Animals Act 1920 or under any equivalent legislation in another Australian jurisdiction, suspended or revoked? or               •         been disqualified from holding such a licence? ο No         ο Yes. Give details: ............................................................................................................... ...............................................................................................................
Signature of applicant or authorised person	......................................................................... ..................................         ( signature )                         ( date )
	Name (please print): Contact Details Postal Address:         .................................................................................. Business Phone:         .................................................................................. Business Fax:         .................................................................................. Mobile Phone:         .................................................................................. Email:         ..................................................................................

[Note: the penalty for giving information in this application that is known to be false or misleading in a material particular is $20 000 and imprisonment for 1 year (s. 76(a) of the Animal Welfare Act 2002 ).]

Form 2

[r. 7]

Animal Welfare Act 2002

Licence to use animals for scientific purposes

Duration of licence	Licence No:         .....................................................................................
	Issued for the period:         ....................................................................
Scientific Establishment	Name:         ...........................................................................................
	Address:         ........................................................................................         ........................................................................................
	Contact person:         .............................................................................
Animals may be used for scientific purposes	This licence permits the named scientific establishment, its staff and students, to use animals for scientific purposes in accordance with the scientific use code for the period of the licence.
Conditions	The use of animals for scientific purposes under this licence is subject to the licence conditions imposed by the Act and regulations, and to the following additional conditions:               •         The licensee must maintain a register of all approved projects and be able to identify current projects.               •         The licensee must establish and maintain a method of ensuring any person who is to be involved in the conduct of an approved project under the licence has the appropriate veterinary skills for that project. This licence may be suspended or revoked for reasons set out in the Animal Welfare Act 2002 , section 17.
________________________________________________ Minister for Local Government and Regional Development

Form 3

[r. 7]

Animal Welfare Act 2002

Licence to supply animals for scientific purposes

Duration of licence	Licence No:         .....................................................................................
	Issued for the period:         .......................................................................
Supplier	Name:         ..............................................................................................
	Address:         ...........................................................................................         ...........................................................................................
	Contact person: ..................................................................................
Animals may be supplied for scientific purposes	This licence permits the scientific establishment and its staff to supply animals for scientific purposes in accordance with the scientific use code.
Place(s) covered by this licence	This licence permits the supply of animals from the following places and facilities: ............................................................................................................ ............................................................................................................ ............................................................................................................ ............................................................................................................
Conditions	The supply of animals for scientific purposes under this licence is subject to the licence conditions imposed by the Act, and to the following additional conditions: ............................................................................................................ ............................................................................................................ ............................................................................................................ ............................................................................................................ This licence may be suspended or revoked for reasons set out in the Animal Welfare Act 2002 , section 17.
________________________________________________ Minister for Local Government and Regional Development