Form Btap1 - Knowledge Transfer (Kt1 - Beef) - The European Agricultural Fund Page 2
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2KT1B
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 Beef Programme.
The participant is required to provide three (3) signatures for verification purposes, against the attendance records.
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: …………………………………………………………………..................................................
K T
Facilitators: KT Ref No:
Please confirm if you are submitting the above applicant as one of your 20% new members
Yes
No
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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