Department Of Agriculture, Food And The Marine - Basic Payment Scheme Form - 2016

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Department of Agriculture, Food and the Marine
BPS /UND/2016
2016 Basic Payment Scheme
This form is to be completed where an entire holding is transferred from one farmer to another between date of application
st
for the Basic Payment Scheme and 1
June 2016 where the transferee agrees to succeed to the responsibilities of the
transferor.
Details relating to original applicant under the Basic Payment Scheme (transferor of entitlements)
Herd Number:
___________________________________________
NAME:
_________________________________________________________________________
ADDRESS:
_______________________________________________
TEL NO:
____________________
MOBILE: ____________________
________/________/__2016__
Date of Transfer of Entire Holding
Date of application for 2016 Basic Payment Scheme ____/____/2016_
Number of entitlements claimed ________
Number of entitlements held by original farmer for 2016______________
Value of entitlements held by original farmer for 2016_____________
Is the entire holding being transferred: Yes
No
Is the transferor deceased: Yes
No
Signature of transferor
(
) : _____________________________________
or, if deceased signature of legal personal representative
Please indicate method of transfer (tick box): Inheritance
Gift
Sale
Lease
Other
If other, please specify:______________________
Details relating to the transferee:
Herd Number:
NAME:
__________________________________________
ADDRESS:
____________________________________________________________________________
____________________________________________________
TEL NO: ________________________
MOBILE: ________________________
Are you already an applicant under the 2016 Basic Payment Scheme (please tick box) Yes
No
DECLARATION OF 2016 UNDERTAKING (must be signed by transferee)
Declaration: I
, the transferee, agree to succeed to the responsibilities of the original applicant regarding compliance with the
terms and conditions of the 2016 Basic Payment Scheme and I wish to apply for payment under the Scheme. I hereby declare that
I have read and understand the Terms and Conditions of the Basic Payment Scheme and agree to be bound by them. I declare that
the information given in this application is complete and accurate in all respects.
Signature of transferee
Date:
(in applicants normal handwriting)

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