Information

  • Document No.

  • Impounded on

  • Impounding/Seizing Officer

  • Other Personnel

SEIZING, IMPOUNDING, SURRENDER DETAILS

SEIZING, IMPOUNDING, SURRENDER DECLARATION

  • Seized, Impounded or Surrendered

  • I declare that the dog/cat was seized by virtue of the Companion Animals Act 1998. I was not able to establish the owner of the dog/cat, prior to surrendering the animal to the pound.

  • I declare that the mentioned animal was impounded from a public place.

  • I surrender my dog/cat to the Authorised Officer, understanding that it MAY BE DESTROYED.

  • Name

  • Address

ORIGIN OF REQUEST

ANIMAL / OWNER DETAILS

ANIMAL OWNER AND DETAILS

  • Time & Date Seized/Impounded

  • Animal Type

  • Gender

  • Name

  • Colour

  • Colour

  • Breed

  • Breed

  • Photo of Animal

  • Location of seizure
  • Microchip Number

  • Is Animal Registered

  • Owners Name

  • Owners Address
  • Owners contact details

  • Other notes if required

  • Authorised Officers Name

TRANSPORTATION OF ANIMAL

TRANSPORTATION OF ANIMAL

  • Conveyed to RSPCA, Owner or Agent

  • Tag Number

  • Items Impounded With Animal

  • Items

  • COMMENTS / WARNINGS

  • RSPCA Impound Officer Name

  • Owners Name

  • Owners Address
  • I am collecting the subject animal on behalf of the owner.

  • Agents Name

  • Agents Address

OFFICE USE ONLY

OFFICE USE ONLY

  • Date letter sent to last registered owner.

  • Number of Days Impounded

  • Total Amount of Fees Charged as per Pound Register

  • Receipt Number

  • Microchip No. On Release

  • Notes :-





  • Animal Released to:- OWNER - AGENT (Circle)

  • ID Sighted

  • Signed

  • Name

  • Address

  • Date

  • Animal was :- TRANSFERRED TO RSPCA - DESTROYED - STOLEN - (circle)

  • Date

  • RSPCA Pound Officers Name

  • Signature

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