Form Btap1 - Knowledge Transfer (Kt1 - Sheep) (Page 2 of 2) in pdf

KT1S

Liability, Indemnity, Authorisation and Declaration.

The DAFM shall not be liable for any direct or indirect loss or liability to the client resulting from the use by a Facilitator of online facilities to

submit an application or associated information or documents for the Knowledge Transfer Programme to the Department on behalf of a

participant. Full responsibility for the data submitted online rests with the facilitator and the participant concerned. The Department reserves

the right to withdraw this service from a facilitator where there is evidence of improper use of the service. Payments may be reduced or

lost where it is found that the participant or facilitator does not adhere to the conditions of the Knowledge Transfer Programme.

I/We authorise the facilitator whose details are set out below to communicate with the DAFM on my/our behalf for the purpose, in the first

instance, of completing and submitting the relevant application form(s) online and thereafter for the submission of my/our details in such format

as may be required from time to time by the Department.

I/We confirm that the information above is correct to the best of my/our knowledge and that it refers to me/us. I/We further confirm that I am/we

are the registered owner(s) of the herd number or other Department identifier mentioned above. I/We authorise the DAFM to forward my/our

personal details to my/our facilitator.

I/We agree that the Department may request/access data held externally in relation to me/us which is required for the purpose of

assessment/verification of my/our application.

I/We further agree that the details supplied in my/our application form, along with any supporting documentation, may be made available within

this Department or to any other body where required for scheme evaluation purposes.

I/We understand that all data held/requested/accessed by the Department is subject to the Data Protection Acts 1998 and 2003.

I/we wish to have the facilitator in respect of whom details are supplied below act on my/our behalf in submitting details online to the DAFM

for the Knowledge Transfer Sheep Programme.

For verification purposes, against the attendance records, the participant is required to provide three (3) signatures.

Participant’s Signature 1: ____________________________________________________

Participant’s Signature 2: ____________________________________________________

Participant’s Signature 3: ____________________________________________________

Please note that this application cannot be accepted if it is not signed by the applicant or where there are joint applicants, by all the

parties concerned. Where this application is made on behalf of a company or other legal entity, the application must be signed by the

authorised officer of that company and the official status of the signature (Director, Secretary etc.) must be stated.

Signature: _________________________________________________________________

Date: _____________

Joint Applicant Signature(s): _________________________________________________

Date: _____________

Status of Signatory (Company): _______________________________________________

Facilitator:

I accept the Knowledge Transfer Facilitator Role and undertake to comply with all the Terms and Conditions of the Knowledge

Transfer Programme including those pertaining to Paragraph 24. I accept that failure to meet those Terms and Conditions may result

in forfeiture of payment.

Name of Facilitator: ............................................................................................................................. .................................

Address of Facilitator: .................................................................................................................................................. ........

Contact Telephone No: .........................................................................................................................................................

Group Name: ........................................................................................................................................................................

Facilitators: KT Ref No:

K T

entrants (Terms & Conditions 7.2.2.)

Please confirm if you are submitting the above applicant as one of your 20% new

Yes

I confirm that the signatures above are those of the applicant and nominee.

Facilitator Signature

Date:

________

Incomplete or illegible forms will be returned, thereby delaying this registration process.

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