National Environmental Management: Biodiversity Act, 2004 (Act No. 10 of 2004)

Annexure 5

STANDING PERMIT

Issued in terms of the provisions of the National Environmental Management: Biodiversity Act, 2004 (Act No. 10 of 2004)

NAME OF ISSUING AUTHORITY

NAME

ADDRESS

PROVINCE

PROVINCIAL DEPARTMENT

NATIONAL DEPARTMENT

PROTECTED AREA MANAGEMENT AUTHORITY

VETERINARIAN

REGISTERED CAPTIVE BREEDING OPERATION

REGISTERED SCIENTIFIC INSTITUTION

REGISTERED SANCTUARY

REGISTERED REHABILITATION FACILITY

REGISTERED COMMERCIAL EXHIBITION FACILITY

REGISTERED GAME FARM

REGISTERED WILDLIFE TRADER

REGISTERED NURSERY

UNIQUE REGISTRATION NUMBER

DETAIL OF PERMIT-HOLDER

NAME

ID NO.

SURNAME

PASSPORT NO.

POSTAL ADDRESS

RESIDENTIAL ADDRESS

ADDRESS

ADDRESS

ADDRESS

TOWN

POSTAL CODE

PROVINCE

DETAIL OF SPECIES INVOLVED

SPECIES

SEX

(if known)

QUANTITY

MARKING

(if applicable)

COMMON NAME

SCIENTIFIC NAME

DETAIL OF RESTRICTED ACTIVITIES INVOLVED

PERMIT VALIDATION

PERIOD OF

VALIDITY

FROM:

TO:

RECEIPT NUMBER

SIGNATURE ISSUING OFFICER

SIGNATURE PERMIT-HOLDER

DATE STAMP: