Planning for Conversion Program

Application form 2015

An initiative of the Into Dairy – Sustainable Dairy Development Project

Please read the Guidelines for this program,which are available from the DairyTaswebsite by contacting the DairyTas office on (03) 6432 2233.

The Planning for Conversion Program is managed and delivered by DairyTas, and has been fully funded by the Tasmanian Government as part of its support for the Tasmanian Dairy Industry Growth Plan by an allocation from the Premier’s Job Package.

In the event that the application form limits responses more comprehensive statements can be provided as attachments. Please note that failure to complete all relevant sections of this Application Form mayresult in delays or deem the application ineligible.

  1. Applicant details

Legal entity:
Trading Name:
ABN: ______/ Registered for GST: YES / NO
Physical location (Street address):
Local Government area:
Postal address:
Contact Details: / Bus Phone: / Mobile Phone:
Email: / Fax:
  1. Contact person details

This person is responsible for all dealings with DairyTas in relation to this application. The person must be authorised to provide further information and receive all notices relevant to the application.

Name:
Position:
Postal address:
Contact Details: / Bus Phone: / Mobile Phone:
Email: / Fax:
  1. Bank account details

Should the application be approved, funds will be deposited into the nominated bank account (below) via Electronic Funds Transfer. Please ensure that the correct details are provided, as provision of incorrect information could result in a payment error.

Name of Bank: / Branch:
BSB: / Account Number:
Account Name:
  1. Business details

4.1Business structure

Sole trader Partnership Company
Trust - provide a copy of the trust deed
Other, please specify

4.2Business description: ______

(Briefly describe your business and current land use):

______

______

4.3Applicant Status

Please indicate which of the following statements best describe your circumstances.

The applicant is the landowner or manager of the land , or
The applicant is a prospective purchaser and has landowner consent (Please attach consent)

4.4Preliminary Checklist – Dairy Conversion feasibility

It is essential to establish an absence of primary impediments or significant constraints as part of the application process to ensure that the joint investment by the applicant and DairyTas will notbe wasted.

A milk processing company is prepared to pick up from the nominated propertyYES / NO

There is suitable main road access to/from the propertyYES / NO

There is adequate electricity infrastructure to the property to support a dairy operationYES /NO

The property has suitable zoning and is not restricted in its agricultural land useYES /NO

(The applicant may need to check these details with local council authorities.)

Should the response to any of the questions above be “NO”, please contact the Program Manager prior to proceeding further with this application.

  1. Project details

5.1Purpose

Please indicate which of the following statements best describe your circumstances.

Dairy is being considered as a diversification strategy for my farm business, or
Dairy is being considered as a future primary enterprise for my farm business
Dairy is being considered as a future enterprise for the property should a purchase proceed

5.2Property details

(Briefly describe property characteristic and location)

______

______

______

______

______

Property particulars: Please provide Certificate of Title reference(s)______

or property identification number(s)______

  1. Required information to be submitted with this application form

To ensure the assessment of the application is not delayed, please use the checklist below to confirm that all requested information has been attached to this application.

Note: Failure to provide all relevant attachmentsmay deem the application ineligible.

If the applicant is a trust, a copy of the trust deed schedule that identifies the trustees of the trust
Proposals/quotations from external consultants for completion of the Conversion Plan
Other attachments and supporting information referenced in your application responses
  1. Declaration

For and on behalf of the applicant detailed on page one of this application, I, the undersigned, acknowledge and warrant (as the case may be) that:

  1. I have authority to provide the information contained in this application and to execute this application for and on behalf of the applicant
  2. DairyTascan rely upon the information and representations contained in this application (including these acknowledgements)
  3. I have read and understand the terms and conditions relating to this application outlined within the guidelines, and agrees to be bound by the said terms and conditions upon the application being approved
  4. I have read and understood the eligibility criteria for the program and declare that to the best of my information, knowledge and belief that the applicant is eligible under the program criteria and that the information provided in this application is true and correct
  5. I understand that the application is made at the applicant’s own cost and risk, the selection of the applicant for program funds is at the absolute discretion of DairyTas and this application remains the property of DairyTas
  6. I understand that I will be responsible for notifying DairyTas in writing of any changes in the above particulars. Until receipt of such notification, DairyTas shall process all payments in accordance with the above particulars
  7. Grant payments are to be made via Electronic Funds Transfer to the nominated bank account provided in this application and DairyTas is hereby authorised to make such payments
  8. DairyTas is under no obligation to verify the authority of the undersigned on the bank account details
  9. It is not practicable for DairyTas to keep banking details confidential, to the extent that these will be available to DairyTas’s staff in carrying out their normal duties in paying creditor accounts. DairyTas will not be responsible for any delays in the payment or errors due to factors outside the reasonable control of the organisation (including but not limited to delays and errors in the banking system). DairyTas reserves the right at any time to terminate or suspend this direct payment method and to pay by cheque or any other manner which the organisation may determine
  10. I agree to indemnify DairyTas against all present and future legal liability, claims or proceedings for financial loss arising from, or attributable to the provision and use of the information contained in this application and/or receipt and use bythe Planning for Conversion Program.

I, the undersigned agree to the terms and conditions of this grant program.
Name of person(s) signing:
Signature: / Position:
Signature: / Position:
Date:
Witness name:
Signature:

DairyTas - Planning for Conversion Application FormPage | 1