Update Your Dali Dog’s Microchip

ONLY COMPLETE AND SUBMIT ONCE YOU HAVE YOUR DOG AND PASSPORT

Important Information

1. The cost of Microchip registration is £20.00.

2. Please send payment via bank transfer to our UK bank account (please use your dog’s Microchip number and their original name as reference):

Bank: Lloyds Bank

Account Name: Dali Dog Rescue

Account Number: 39468062

Sort Code: 30 98 97

Please note your dog’s microchip will not be updated until payment has been received. If you have any questions or need support filling out this form, please email dalidoguk@gmail.com.

Microchip Update Form

Rescue Name

Please amend if your dog is from a Shelter other than Dali Dog Rescue

Dogs Original Name

Please enter the name of you dog as advertised in the shelters adoption ad

Dog's New Name

Microchip Number

Please enter the 15 digit number found on page 6 of your pet passport

Microchip Implant Date

Implant date is also on page 6 (number 2), date of application or reading

Dogs date of birth

Date of birth is found on page 5 of the pet passport

Pet Passport Number

Breed Description

Coat Colour

Is your dog neutered or spayed?

Yes

Unknown

Dogs Gender

Male

Female

Does your dog have any known conditions?

If yes, please provide a brief description. If not please clearly state: N/A

New Keeper's Details

Title

Name

First Name

Last Name

Home Telephone No.

Mobile No.

Alternative Telephone No.

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Adopter Microchip Registration Privacy Notice

D.O.G Rescue Cyprus takes your privacy seriously and we will only use your personal data on this form in connection with your microchip registration. D.O.G Rescue Cyprus will never pass your information to any third party not connected to the process, and the details will not be used for marketing purposes of any third party. Your Microchip Registration Form will only be held securely both electronically and/or on hard copy. Further information on our data protection and privacy is contained in our Data Protection Policy and our Privacy and Cookies Policy.

I give my consent to the information on this form to be stored and processed by D.O.G Rescue Cyprus for the purposes of microchip registration.

I consent