Department of Agriculture, Food and the Marine ER1.1 /

Application form to register an interest in the role as ‘Herdowners’ in a herd number. revised November 2004

Declaration I/We the undersigned declare that we have an interest in the herdnumber

Or the herd the subject of the attached ER1 application form. (Delete as appropriate)

I/We hereby agree that is the Keeper acting on our behalf.

I/We agree to the conditions attaching to the issue of the herd number.

(The conditions are on form ER1 that is attached and/or are available in the District Veterinary Office).

Any grants and subsidies that may fall due will be paid to the person(s) nominated on this form or to a bank account specified in form ERBD (Available in the District Veterinary Office).

Note 1: - Legal advice should be sought in establishing partnerships and joint interests.

Note 2: - All correspondence with ‘Herdowner’ will be made to address detailed in 1 below.

(Please Tick  and print clearly using block capitals - sign and date 1- 4 as appropriate)

1. / Mr. / Ms / Name(s)
Date of Birth* / Postal Address
* All applicants must be over18 years of age / Farmer Status / Full /
Part / State any other herd numbers you have an interest in
–If any
PPS No
Signed: / Date _____/______/20_____.

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2 / Mr. / Ms / Name(s)
Date of Birth* / Address
* All applicants must be over18 years of age / Farmer Status / Full /
Part / State any other herd numbers you have an interest in
–If any
PPS No
Signed: / Date _____/______/20_____.

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3 / Mr. / Ms / Name(s)
Date of Birth* / Address
* All applicants must be over18 / Farmer Status / Full /
Part / State any other herd numbers you have an interest in
–If any
PPS No
Signed: / Date _____/______/20_____.

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4 / Mr. / Ms / Name(s)
Date of Birth* / Address
* All applicants must be over18 / Farmer Status / Full /
Part / State any other herd numbers you have an interest in
–If any
PPS No
Signed: / Date _____/______/20_____.

Signed, in acknowledgement, by Keeper nominated above and/or applicant on ER1 accompanying: -

(Even if the keeper is one of the parties above being registered as a ‘herdowner’)

______Date _____/______/20_____.