Is The Animal Registered
Second Contact Details
SEIZE, SURRENDER, IMPOUND - DECLARATION
I declare that the mentioned animal was impounded from a public place.
I declare that the subject animal was seized by virtue of the Companion Animals Act 1998. I was not able to establish the owner of the animal, prior to surrendering the animal to the pound.
I surrender my dog / cat to the Authorised Officer, UNDERSTANDING THAT IT MAY BE DESTROYED.
Address (if not owner)
TRANSPORTATION OF ANIMAL
Was the animal conveyed to the RSPCA, Owner or Agent
OFFICE USE ONLY
Number of days impounded.
Total of fees charged as per pound register.
Animal identification number on release. M/C No.
The animal mentioned was -
Returned to owner/agent.
Transferred to RSPCA
Name of Owner/Agent
Address of Owner/Agent
Type of ID Provided by Owner/Agent
Signature of Owner/Agent
Pound Officers name