Poultry Registration Application Form (PR1 form)
| Published date | 09 October 2020 |
Application for Registration of a Poultry Premises (PR1)
1.
Keeper details
Owner details – if different to keeper
Name
Address
Eircode
Date of birth
/ /
/ /
PPSN / VAT
Mobile phone
Landline
Email
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2.
Site details - remember each site at which poultry is kept requires its own flock number.
Site co-ordinates: Longitude___________________________ Lat itude_______________________
Site address (if different to the keeper’s postal address):
________________________________________________________________________________________________________________________
3.
Please list any other herd numbers registered in your name (cattle,
sheep, goats etc)
4.
Proposed / updated number of poultry on premises
5.
Number of poultry houses on site
6.
Does the flock have outdoor access?
Yes
No
7.
Name and address of the person/business poultry was sourced from (only most recent source)
________________________________________________________________________ _________________________
8.
Type of activity/poultry use
Tick
a.
Own Consumption ie
so
lely
fo
r c
onsu
m
p
ti
on
b
y
p
er
sons
on
t
h
e
ho
l
d
i
n
g
b.
Supply Without Payment ie for supply outside the site without payment for consumption by
others (e.g. family or friends)
c.
Commercial ie
Pl
a
ci
n
g
of
live
pou
ltry, me
a
t
o
r egg
s
on
t
h
e m
a
rket (selling)
d.
Other
(
e
.
g
.
b
ir
ds/pou
ltry ke
p
t
as pets only or as captive birds in a zoo, aviary etc) :
__________________________________________________________________________________________________________
9. Tick all categories that apply to your flock
Backyard
Egg Producer
Fancy Fowl
Egg Packing
Aviary
Local Market
Open Pet Farm
Small Abattoir
Racing/Breeding Pigeons
Hatchery (please state incubator capacity)
Ratite
Farm
Game
Quarantine
Pet Shop
Other (please specify below):
__________________________
__________________________
__________________________
Zoo
Broiler
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