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