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Department of Agriculture, Fisheries and

An Roinn Talmhaiochta, Iascaigh agus

Food

Bia

Government Offices

Oifigí Rialtais

Old Abbeyleix Road

Seanbhothár Mháinistir Laoise

Portlaoise

Co. Laois

Co. Laoise

SPS Auth 3

Lo Call: 1890 252 118

Form for use by either an SPS Applicant or an Agriculture Agent for the purpose of terminating the Authorisation of an Agriculture Agent(s) to act on

behalf of a Single Payment Scheme (SPS) Applicant in submitting that applicant’s SPS applications online. This Authorisation was put in place on

the receipt in the Department of a completed SPS Auth 1 form.

Agent’s details.

SPS Applicant’s Details

AGT

First Agent Number:

____________________________

Name: __________________________________________________

As held by the Department of Agriculture & Food

First Agent Name: ____________________________________

Address:__________________________________________

AGT

Second Agent Number:

____________________________

_______________________________________

Second Agent Name___________________________________

Currently working on behalf of

Herd Number: ___________________________

Agency Name: ____________________________________________

SPS Applicant’s Termination request

Agency Address: __________________________________________

With effect from ____/_____/_____, I/we wish to terminate the arrangement,

_________________________________________________________

previously notified to the Department by way of an SPS Auth 1 form,

between me/us and the Agriculture Agent(s) listed across. Please make the

Agent’s Termination request.

necessary changes on the Department’s computerised system to affect this

request.

I confirm that I fully understand that, by submitting this request, the

With effect from ____/_____/_____, I wish to terminate the arrangement,

present arrangement with the Agriculture Agent(s) listed across will be

previously notified to the Department by way of an SPS Auth 1 form,

terminated with immediate effect and that the Agent(s) listed across will no

between me and the SPS Applicant(s) listed across. Please make the

longer be in a position to submit SPS application forms online on my behalf

necessary changes on the Department’s computerised system to affect

and that the Agent(s) will no longer be in a position to access online any of

this request.

my/our SPS details.

I confirm that I fully understand that, by submitting this request, the

present arrangement with the SPS Applicant(s) listed across will be

Signed: ____________________________________

terminated with immediate effect and that I will no longer be in a

position to submit SPS application forms online on behalf of that

Signed: ____________________________________

applicant(s) and I will no longer be in a position to access online any of

If the Herd Number is owned in joint names, all parties must sign this form.

that applicant’s SPS details.

Date: ______________________________

Signed: _________________________________________

Position in Company: _______________________

Date: ____________________________________

For Companies Only

SPS Applicant’s signature is not required. Please advise SPS Applicant.

Signature of Agent(s) not required. Please advise Agent(s).

For Official Use Only – CCS

Customer disconnected from Agent no.

AGT

Recorded by

Date recorded

(Enter Agent No):

Customer disconnected from Agent no.

AGT

Recorded by

Date recorded

(Enter Agent No):

Form Sps Auth 3 - Authorisation Of An Agriculture Agent(S) Termination Form - Department Of Agriculture, Fisheries And Food

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