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Transfer of Hound Ownership

To transfer ownership of a registered hound from the currently registered owner to another person, the new owner must complete this form. A separate form is required for each hound being transferred. It is the new owner’s responsibility to ensure that the completed form is sent to Game Licensing Service at GPO Box 4440, Melbourne VIC 3001.

1. Registered Owner:

Please write clearly and in BLOCK letters

Customer No:

Name:

2. Hound Details:

Please write clearly and in BLOCK letters

Registration No:

Breed:

Colour:

Sex:

Microchipped ?

Microchip No:

Hound name:

3. New Owner:

Please write clearly and in BLOCK letters

Customer No:

Game Licence No:

First Name:

Middle Name:

Family Name:

Date of Birth:

Postal Address:

Telephone No:

Declaration by New Owner:

I, (the above-named ‘New Owner’), authorise the Department of Primary Industries to record my Personal Information (above) in accordance with the principles set out in the Victorian Information Privacy Act 2000 and to disclose this information to a centralised microchip registry, if necessary. I understand and accept that only information necessary to enable the return of a missing hound or to assist with council pet registrations will be disclosed by the centralised microchip registry (except as required for law enforcement purposes). To my knowledge, my hound is in good health and does not suffer from haemophilia or any other related blood clotting disorders. To my knowledge, my hound does not already have a microchip implant other than the one described above (if any).

Signature of New Owner: ……………………………………………………… Date: …… / …… / …………

Department of Primary Industries

game hunting

Transfer of Hound Ownership

1. Registered Owner:

2. Hound Details:

3. New Owner:

Declaration by New Owner: