NEW ANIMAL REGISTRATION APPLICATION FORM
All cats and dogs over 3 months of age and being registered for the first time MUST be microchipped. This
will include any previously registered cats and dogs that move to the Mornington Peninsula Shire, from
another municipality. Council is unable to accept registration unless the animal is microchipped.
This form WILL NOT be processed without proof of microchipping.
The Shire’s General Purposes Local Law 2012 Part 5 No 44 (3) require the de-sexing of a CAT over the age
of 3 months, unless the Owner has applied for a Permit and the owner of the cat is a member of an
Applicable Organisation, with which the cat is registered.
WARNING: If this application will result in more than the prescribed number of cats and dogs shown in the
table below being housed at this address, you may require a Local Law Permit. Please contact Customer
Service on 1300 850 600, during business hours (8.30am-5.00pm, Mon to Fri), before completing this application.
PROPERTY
SIZE
Dogs
Cats
>499
s/mtrs
1
2
500-1,199
s/mtrs
2
2
1,200-2,499
s/mtrs
2
2
2,500-4,999
s/mtrs
3
2
>5,000
s/mtrs
>10,000
s/mtrs
3
2
3
2
ANIMAL OWNER DETAILS :( Owner must be over 18 years)
Owner’s Name:
DOB:
Residential Address:
Postcode:
Postal Address (if
different):
Postcode:
Home Ph
Business Ph
Mobile
Email Address:
Do you authorise the Shire to provide your telephone details
to a third party for the purposes of reuniting you with your
pet if it is lost?
YES
NO
Pension Concession Card No
(Does not apply to health care
card):Attach proof see below
ANIMAL DETAILS:
Animal Type:
DOG
CAT
Animal Name:
Address where animal kept:
Animal Date of Birth:
Animal Breed:
Animal Colour:
Animal Gender:
Desexed:(Please attach
proof) see below
MALE
FEMALE
YES
NO
Descriptions / Details:
Microchip Number(Please
attach proof) see below
Proof of microchipping / desexing and copy of both sides of pension card (if
applicable) must be attached to this application for the Registration to proceed.
DOC ID: A5767130
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ANIMAL REGISTRATION APPLICATION FORM
For Dog Registrations only:
IMPORTANT NOTICE - REGARDING RESTRICTED BREED DOGS
The state Government has made significant amendments to the Domestic Animal Act 1994 in relation to the
keeping of 'RESTRICTED BREED DOGS'. A 'RESTRICTED BREED DOG' means a dog of a breed whose
importation into Australia is prohibited under the Customs (Prohibited Imports) Regulations 1956 of the
Commonwealth. These breeds include: Dog Argentino, Fila Brasileiro, Japanese Tosa, American Pit
Bull Terrier, Pit Bull Terrier, Perro de Presa Canario and Presa Canario.
A declaration is required stating that the breed of dog has been correctly identified by the owner.
Declaration:
I declare that the dog identified in this certificate has been correctly indicated as to whether it is or not a
restricted breed as listed above.
Date:
Signed:
Name (print):
REGISTRATION FEES for the 2016-17 Registration years (Full year charge).
Pension Concession(Proof must be supplied see
previous page) Does not apply to Health Care Cards
Total Fee
Total Fee
Dog(Desexed)
$37.50(includes $3.50 Govt Levy)
Dog(Desexed)
$20.50 (includes $3.50 Govt Levy)
Dog Entire
$175.00(includes $3.50 Govt Levy)
Dog Entire
$89.00 (includes $3.50 Govt Levy)
Cat(Desexed)
$36.00(includes $2.00 Govt Levy)
Cat(Desexed)
$19.00(includes $2.00 Govt Levy)
Dog (over 10yrs old)
$37.50(includes $3.50 Govt Levy)
Dog (over 10yrs old)
$20.50(includes $2.00 Govt Levy)
PAYMENT METHODS
 Credit card - fill in details below or Customer Service will telephone you if you do not
wish to provide your Card Details
 Email:- [email protected] or fax 5986 6696
CREDIT CARD PAYMENT:
Mastercard  Visa Card 
Cardholders Name: ___________________________________________
Card No: _ _ _ _ / _ _ _ _ / _ _ _ _ / _ _ _ _
Exp: _ _ / _ _
Amount: $ _________
Cardholders Signature: ________________________________________

Cheque/Money Orders made payable to: Mornington Peninsula Shire and send to
Mornington Peninsula Shire Private Bag 1000 Rosebud Vic 3939
In person during Office Hours: - 8.30am -5.00pm Monday to Friday


2 Queen Street Mornington
90 Besgrove Street Rosebud
21 Marine Parade Hastings
14 Edward Street Somerville
The Shire is collecting personal information on this form in accordance with its legislative powers and functions and it will only be used
and disclosed in accordance with those powers and functions. You may access the information by contacting the Shire.
DOC ID: A5767130
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