Owner/Agency Information Full Name Email Street Address City State---VICTASNSWACTSAWANTQLD Postcode Contact Number Age---18 to 2425 to 3435 to 4445 to 5455 to 6465 or over Pet Information Pet's Name Date of Birth Age of Pet Pet's Breed Pet's Sex---MaleFemaleDon't know Is your Pet Desexed?---YesNoDon't know Is your Pet Microchipped?---YesNoDon't know Pet Insurance (veterinary care)?---YesNo Support required Veterinary care Describe the illness/injury: Name of Vet If you are requiring veterinary support, you must complete the Quote field and upload a copy of the quote. Quote ($) Upload quote I provide BAWCS with authority to speak with the treating vet(s) or associated personnel about my pets needs and associated finances.---YesNo Pet Accommodation: tick which applies Domestic violence support emergencyEntry into Rehabilitation ProgramOther Please specify: Pound reclaim: (mandatory to provide, your application will not progress without it) Cost ($) POUND Animal ID number Outreach visits/ pet supplies: (please detail number of pets and if supplies will be required) Dog training (instead of surrender). Please advise the issues you are having with your dog. Need: Pension / Disadvantage BAWCS assists pet owners in 'necessitous circumstances' and the ATO require knowledge relating to the following: What type of pension are you on? (Note: proof of this will be required if your application progresses) Other extenuating circumstances, mental health, children, etc (please note, the more information you provide regarding your circumstances to support your request for support, the more likely you are going to be approved.) Social: Marital status---MarriedDe-factoSingle Accommodation---RentingMortgagedOwner Financial: How reliant are you on your Centrelink pension? i.e. Do you have any other financial income? (please note, the more information you provide regarding your circumstances to support your request for support, the more likely you are going to be approved.) What steps have you taken to pay for your pets required care? (please note, the more information you provide regarding your circumstances to support your request for support, the more likely you are going to be approved.) How much can you afford to contribute? (please note, even a small contribution will support your request for assistance.)($) Δ
