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EBASA Membership Application Form 2023
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Section A - Personal details
Full Name
*
First
Last
ID Number
*
Address
*
Address Line 1
Address Line 2
City
State / Province / Region
Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia (Plurinational State of)
Bonaire, Saint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo (Democratic Republic of the)
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Kingdom of)
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran (Islamic Republic of)
Iraq
Ireland (Republic of)
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea (Democratic People's Republic of)
Korea (Republic of)
Kosovo
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia (Federated States of)
Moldova (Republic of)
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia (Republic of)
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine (State of)
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Republic of China
Tajikistan
Tanzania (United Republic of)
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom of Great Britain and Northern Ireland
United States Minor Outlying Islands
United States of America
Uruguay
Uzbekistan
Vanuatu
Vatican City State
Venezuela (Bolivarian Republic of)
Vietnam
Virgin Islands (British)
Virgin Islands (U.S.)
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Email
*
Cell Number
*
Section B - Species declaration
Species that you keep
Parrots
Parakeets
Lorikeets / Loris
Finches
Canaries
Doves
Toucans/ Aracaris
Turacos/ Softbills
Racing Pigeons
Fancy Pigeons
Exotic Pigeons
Birds of prey
Waterfowl
Quail/ Pheasant
Ornamental Fowl
Snakes
Lizards
Geckos
Chameleons
Amphibians
Tropical Fish
Freshwater Fish
Marine Fish
Tortoises/ turtles
Monkeys
Primates/ Lemurs
Ringnecked parakeets
Other
Other Species - Please Specify
Annual Fees:
*
New Member - R 250
New Junior Member (16yrs and under) – R120
Family Membership - R480 (2 adults + children <16yrs old in same household)
Ringneck Permit Application fee
Corporate Membership - from R1200 (enquire)
Membership Fees - Joining Jan-Mar: 100% of fee. Apr - Jun: 75% of fee. Jul - Sep: 50% of fee. Oct - Dec: 25% of fee
Membership expires 31 Dec 2023. Membership renewable on an annual basis. Membership runs according to a calendar year i.e. Jan-Dec. Full membership fees due on renewal.
Section C - Special requirement species declaration
CITES 1 LISTED SPECIES CATEGORY
No, I do not keep any CITES 1 species
Yes, I do keep CITES 1 species
List Species:
Permit Number if available:
INDIGENOUS SPECIES CATEGORY
No, I do not keep any indigenous species
Yes, I do keep indigenous species
List Species:
Permit Number if available:
ALIEN AND INVASIVE SPECIES CATEGORY
No, I do not keep any AIS species
Yes, I do keep AIS species
Yes, I do keep Psittacula Krameri sp commonly referred to as Ringnecked parakeets, inclusive of Indian and African Ringnecked parakeets
If not in possession of a valid permit for Psittacula Krameri sp (Ringnecked parakeets), please complete Section C of the application form
List Species:
Permit Number if available:
Section D - Alien and invasive species permit for Ringnecked parakeets(Psittacula Krameri)
GENERAL REQUIREMENTS FOR RINGNECKED PARAKEETS (PSITTACULA KRAMERI)
Number of Ringnecked Parakeets that are kept on the premises
Males
Females
Unsexed
Total
Enclosed safety corridor/ passage/ double entry system to the exterior of the cage/ aviary to prevent escape.
Yes
No
Cage wire spacing less than 25x50mm
Yes
No
Cage wire thickness at least 1.5mm
Yes
No
General condition of aviaries are good to ensure birds cannot escape
Yes
No
Additional Comments:
Acknowledgements for Ringnecked Parakeets (PSITTACULA KRAMERI)
I am aware that Psittacula Krameri commonly known as the Indian Ringnecked Parakeet and African Ringnecked Parakeet, is listed as an invasive species in terms of the Alien and Invasive Species Regulations of 2014 of the National Environmental Management: Biodiversity Act, 2004 (Act no.10 of 2004).
I will take all necessary steps to prevent the escape and spread of the Indian Ringnecked Parakeets from my property.
I will submit a clear video and pictures of my aviaries/ cages to EBASA for a virtual inspection.
I acknowledge that, should I not meet the requirements as set out by the DEA and EBASA, I commit to engage with EBASA to determine a reasonable timeframe for me to become fully compliant.
I accept that onsite inspections by DEA and EBASA may occur at any time.
I accept that a Compliance Certificate will only be furnished once I have met all the criteria as set out by the DEA and EBASA
I undertake to comply with all obligations in terms of the conditions of the permit issued through EBASA.
I further undertake to inform EBASA of any changes relating to my aviaries/ cages/ setup prior to such changes being instituted.
I Agree
I DECLARE THAT ALL INFORMATION SUBMITTED IS TRUE AND CORRECT.
*
I Agree
On approval of the application, banking details will be supplied for payment of the prescribed fees.
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