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