Game and Feral Animal Control Act 2002
Game and Feral Animal Control Regulation 2012
FORM D: Application for a Replacement
NSW Game Hunting Licence
Use this form if your licence has been lost, destroyed or defaced and you need a replacement NSW General or
Restricted Game Hunting Licence.
If available, please provide your last NSW General or Restricted Game Hunting
Licence number (if known):
(please note, this is not your Firearms Licence number)
A. Personal details (Please use CAPITALS and write clearly)
* denotes mandatory field
Please enter your full legal name (preferred name not accepted)*
Title*:
Family name*:
(Mr/Mrs/Miss/Ms/Dr)
First name*:
Date of birth*:
Other given names*:
/
/
Gender*:
Male
□
Female
□
Please provide an email to receive important updates and alerts via email.
Contact information:
Email address:
Please provide an email address to receive important updates and alerts via email.
Home Phone:
Work Phone:
Fax:
Mobile:
* You must include at least one (1) phone contact on your application (mobile number preferred) in case of emergency.
Residential address:
Unit / house number*:
Street name and type*:
Suburb*:
State*:
Postcode*:
State*:
Postcode*:
Postal address:
Unit / house number*:
Suburb*:
Street name and type*:
Office use only
Licence number:
April 2015
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FORM D: Application for a Replacement NSW Game Hunting Licence
B. Replacement fee
The fee to replace a lost, destroyed or defaced NSW Game Hunting Licence is $30.00* (GST exempt).
There is no concession rate available for this fee. Your replacement licence will be issued for the remainder of the period stated on the
existing licence that you are replacing.
*Licence fees are subject to annual CPI increases and may differ from those stated on this form. By signing this document you
are acknowledging that the current fee at the time of processing your application will be applied to your payment.
Current licence fees can be viewed at www.dpi.nsw.gov.au/hunting.
C. Parent/legal guardian consent for junior applicants
I, ________________________________________, of ________________________________________________________,
(full name of Parent/Legal Guardian)
(full residential address)
hereby give permission for __________________________________ requires a replacement NSW Game Hunting Licence
(full name of applicant)
Signature of Parent/Legal Guardian:_____________________________________ Date: ______________________________
D. Payment
I have attached a:
Bank cheque
Personal cheque
Money order
Please make your cheque or money order payable to NSW Department of Primary Industries.
OR
Credit card details
Cardholder’s name
as it appears on the card
Card type
Visa
MasterCard
Card number
Expiry date month/year
Cardholder’s signature
/
Date
All credit card transactions attract a surcharge of 0.4% (subject to change at government direction without prior notice).
PRIVACY INFORMATION - The personal information provided by you on this form is subject to the Privacy & Personal Information
Protection Act 1998. It is being collected by NSW Trade & Investment and will be used for purposes related to your application under the
Game and Feral Animal Control Act 2002. Provision of this information is voluntary and where relevant information is not provided this
may lead to your application being refused, delayed or not further considered. You have the right to request access to, and correct details
of, your personal information held by the Department. Further information regarding privacy can be obtained from the NSW Trade &
Investment website (which includes the Department of Primary Industries) at http://www.trade.nsw.gov.au/legal/privacy
Information provided by you on this form may be disclosed to third parties for law enforcement purposes. Third parties may include NSW
Police Force (including NSW Police Force Firearms Registry), Forestry Corporation of NSW and other agencies where appropriate.
April 2015
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FORM D: Application for a Replacement NSW Game Hunting Licence
E. Declaration
You must read and acknowledge the following statements. Please circle YES or NO.
I declare that the information provided in the application is true and correct. I understand that it is an offence to
provide information or a document that is false or misleading.
Section 27(2) Game & Feral Animal Control Act 2002.
In the previous 10 years have you been found guilty of an offence under the Firearms Act 1996 that is, in
accordance with section 84 of that Act, an offence that may be (or is required to be) prosecuted on indictment?
YES / NO
YES / NO
Section 21(4) Game & Feral Animal Control Act 2002.
In the previous 10 years have you been found guilty of any other offence relating to firearms in NSW or
elsewhere?
YES / NO
Section 21(3)(c) Game & Feral Animal Control Act 2002
Have you been found guilty of any offence in NSW or elsewhere in the past 10 years involving cruelty or harm to
animals, personal violence, damage to property or unlawful entry onto land?
Section 21(3)(a) Game & Feral Animal Control Act 2002
YES / NO
Have you been found guilty of an offence in NSW of releasing a game animal into the wild for the purpose of
hunting the animal or its descendants?
Section 55 Game & Feral Animal Control Act 2002
YES / NO
In the previous 10 years have you been found guilty of an offence under Section 32C of the Forestry Act 1916
(before its repeal on 31 December 2012) or under Section 68 of the Forestry Act 2012 (offences relating to hunting
and using firearms)?
Clause 17 Game and Feral Animal Control Regulation 2012
YES / NO
In the previous 10 years been refused a hunting permit under Section 32B of the Forestry Act 1916 (before its
repeal on 6 August 2004) or under Section 68 of the Forestry Act 2012 or have had such a permit cancelled?
Clause 17 Game and Feral Animal Control Regulation 2012
YES / NO
Signature:
Date:
/
/
F. Submitting your form
By email (preferred):
[email protected]
By mail:
NSW Department of Primary Industries
Locked Bag 21
ORANGE NSW 2800
By fax:
02 6361 2093
(please ensure all pages are sent
consecutively)
For licensing inquiries, please phone 02 6391 3750, email [email protected] or visit www.dpi.nsw.gov.au/hunting
To avoid delays in processing your application, please ensure you have provided all the information required. Please allow processing
time of 20 working days (four weeks) from receipt of your application, or longer during peak seasons and holidays, (exclusive of
postage).
Office use only
Amount:
$
Entered by:
Approved by:
Return Number
All sections checked and information verified?
Database notes added as required?
GL account: 420330
Project code: GLU3-2
Amount GST exempt
Z code: Z4024
Tax code: 500
$
Receipt transaction number:
April 2015
Total $
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