Form Btap1 - Knowledge Transfer (Kt1 - Sheep)

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KT1S
Knowledge Transfer (KT1 - SHEEP)
(Please complete fully in BLOCK CAPITALS)
Herd Number:
Date of Birth
: ..................../...................../......................
Name(s): .............................................................................
Contact Telephone No
: .................................................
.............................................................................
If in joint ownership please state the name of
Address: ..............................................................................
the individual that will be a participant in the
Programme:
..............................................................................
..............................................................................
...........................................................................................
Are you a member of a Registered Farm Partnership
YES
NO
Please state the name of the individual participating on behalf of the Partnership:
..................................................................................................................................
If YES, State the Registered Farm Partnership Number:
Is the farm operating as a Company
YES
NO
Company Number: ..............................................................
Please state the name of the individual participating on behalf of the Company:
............................................................................................................................. ...........................................................................
Please indicate under which eligibility criteria you are applying for in order to participate in Knowledge Transfer Sheep
Programme (one of these boxed must be ticked) :
Have 30 Breeding Ewes (over 12 months of age) on the 2015 Sheep Census
Or
Have 100 Remaining Sheep on the 2015 Sheep Census
Nominee:
Name of nominee for the duration of the programme (see (ii) below):
......................................................................................................................................................................................................
Address of nominee: .................................................................................................................. ..................................................
............................................................................................................... ........................Date of Birth: ............/............/..............
The nominee is required to provide three (3) signatures for verification purposes, against the attendance records.
Nominee’s Signature 1: ............................................................................................................................. ................................
Nominee’s Signature 2: .............................................................................................................................................................
Nominee’s Signature 3: .............................................................................................................................................................
Undertakings
(i)
I certify that all the information is true and accurate and I accept that any false or misleading information may render this application null and void.
(ii)
I certify that I meet the eligibility criteria as outlined in the Terms and Conditions of the Knowledge Transfer Sheep Programme. Where I have
nominated a person to attend on my behalf, this is in accordance with paragraph 11 of the Terms & Conditions of the Knowledge Transfer Sheep
Programme.
(iii)
I undertake to comply with the Terms and Conditions and accept that failure to meet those Terms and Conditions may result in forfeiture of
payment.
(iv)
I undertake to keep all necessary records pertaining to the Knowledge Transfer Sheep programme and the Farm Improvement Plan for verification
by the facilitator and inspection by the Department of Agriculture, Food and the Marine (DAFM) for a period up to and including 18 months after
the end of the Programme.
(v)
I understand that the DAFM Knowledge Transfer data may be used for statistical and evaluation purposes and no individual will be identified.
(vi)
Knowledge Transfer data will be shared with Bord Bia, Teagasc, Health and Safety Authority for the purposes of compliance with this Knowledge
Transfer Programme (Appendix 4).
Incomplete or illegible forms will be returned, thereby delaying this registration process.
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