Application for Desexing Subsidy

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Application for Desexing Subsidy

* All mandatory fields must be completed

Application for Desexing Subsidy

CONDITIONS OF APPLICATION:

Must be a Liverpool City Council resident.
Must provide copy of a valid pension card.
Must have desexed and registered the animal no more than 30 days prior to applying for this subsidy.
Must provide copy of desexing certificate.
Must provide copy of paid invoice for desexing service in the name of the applicant, detailing microchip number, name and breed of the animal desexed.
Council will contribute up to One Hundred dollars ($100)**

IMPORTANT: If you are applying for more than one animal a form for each animal needs to be completed.

**Council reserves the right to reject any application without notice.

Your Details

Full Name: *

Address: *

Postal Address: *

If the same as your address above type 'as above'

Phone number *

Email: *

About your Animal

Microchip Number: *

Lifetime Registration Date: *

Animal Species: *

Animal's Name: *

Animal's Breed: *

Documents

Please upload a copy of your valid pension card:

Upload file *

No file selected

Please upload a copy of the desexing certificate:

Upload file *

No file selected

Please upload a copy of the paid invoice for desexing service in the name of the applicant, detailing the microchip number, name and breed of the animal desexed:

Upload file *

No file selected

Banking Details

Name on Bank Account: *

Bank Name: *

Branch Number (BSB): *

Account Number: *

Authorisation

Agreement: *

I authorise Liverpool City Council to make credit payments into the above bank account.

Declaration

I declare the following: *

The information given above is true and correct.
I am the owner of the animal specified in this application.
I affirm that the amount listed on the invoice has been paid in full for desexing.
I will not hold Liverpool City Council responsible for any costs involved for the veterinary treatment of my companion animal.