ANCA

Demander une subvention

Name of Farming Group / Cooperative

Total number of members

Male

Female

Date group was established

Address

Phone

Contact person 1

Last name

Position

Phone

Identification (please attach a copy to application form)

Passport

National ID

Voters Registration card

Education

Postgraduate degree

Undergraduate degree

High school diploma/certificate

Farm Size (hectars )

Farm location

Type of farming practiced

Subsistence farming

Commercial farming

How old is the farm?

Type of Crop Cultivated

Area under cultivation (hec)

Please tick the appropriate box(es) to identify the objectives which your proposal will meet.

To reduce production costs

To diversify farming operation

To improve quality/ add value to products

To expand the size of farming operation

To expand the size of the farm

Total amount being requested (€)

Brief description of operations to be undertaken (attach separate sheets if necessary)

How will the grant be used to support the proposed operations? Provide a breakdown for associated costs

Detailed plan of proposed operation (attach work plan on separate sheet if necessary)

We the undersigned representatives of the below named farmer group / cooperative hereby apply for this farming grant in respect of the proposal stated in Part V of this form and declare that:

- This farming group / cooperative is the owner/tenant/subtenant/leaser of the farmland on which the proposed work is to be carried out.  Within 6 months of receipt of grant, evidence will be provided to indicate implementation of the proposed activities.

- We agree to allow an authorized person access to lands and facilities relating to this application to collect additional information as may be required.

- If the support received through the grant scheme is not used principally for agricultural purposed, the farming group / cooperative will be required to repay the money with interest.

- To the best of our knowledge and belief, the particulars given in this form are correct.

Name of farming group / cooperative:

YOU ARE RESPONSIBLE FOR ENSURING THAT ALL INFORMATION PROVIDED IN SUPPORT OF AN APPLICATION / CLAIM IS ACCURATE IN ALL MATERIAL RESPECTS. WHERE IT IS ESTABLISHED THAT ANY INFORMATION PROVIDED IN SUPPORT OF THE APPLICATION IS MATERIALLY FALSE OR MISLEADING, THIS WILL RESULT IN DENIAL OF THE GRANT OR RECOVERY OF ALL GRANT PAID WITH INTEREST, AND MAY ALSO INVOKE LEGAL PROCEEDINGS.

Agree

Name / Signature of representative 1:

Name / Signature of representative 2:

ANCA

Demander une subvention

Détails du groupe agricole / coopérativeDétails du groupe agricole / coopérative

COORDONNÉES DES REPRÉSENTANTS DU GROUPECOORDONNÉES DES REPRÉSENTANTS DU GROUPE

Statut de groupement agricole / coopérative / entrepriseStatut de groupement agricole / coopérative / entreprise

Details of Farming practicedDetails of Farming practiced

Summary of grant proposalSummary of grant proposal

Declaration (to be signed by official representatives ofthe farming group or cooperative)Declaration (to be signed by official representatives ofthe farming group or cooperative)