Form STAP1

Sheep Technology Adoption Programme (STAP) – Application Form

(Please complete fully in BLOCK CAPITALS)

Title: / Forename: / Surname:
Address: …………………………………………...
……………………………………………......
………………………………………....…......
County: ...... / Herd Number:
Mobile No:
Telephone No:
LQAS Member (Y/N): ………………………..
or
LQAS New Applicant (Y/N): / BTAP Participant or intending to apply? (Y/N)
……………………......
Member of existing BTAP discussion group (Y/N):
If YES, name of group: …………………………………………………………......
If YES, name/address of facilitator: ………………………………………..……......
Name of person nominated to attend on my behalf
(see (ii) below):
Note: Aid will be payable in accordance with EU State Aid Rules - See Terms and Conditions and viii below

Undertakings

(i)  I certify that the foregoing information is true and accurate and I accept that any false or misleading information may render this application null and void.

(ii)  I certify that I meet the eligibility criteria as outlined in the Terms and Conditions of the STAP. Where I have nominated a person to attend on my behalf, this is in accordance with paragraph 9 of the STAP.

(iii)  I understand that I may be required to host my discussion group on my farm.

(iv) I undertake to comply with the Terms and Conditions and accept that failure to meet those Terms and Conditions may result in forfeiture of payment.

(v) I undertake to keep all necessary records pertaining to the STAP and the selected tasks for verification by the facilitator and inspection by DAFM for a period of 3 years.

(vi) I undertake to pay the facilitator the relevant fee upon commencement of my involvement in the Programme.

(vii) I understand and agree that my Sheep census data shall be made available to Sheep Ireland for sheep breeding purposes generally and is not restricted to the term of this programme, but this permission to use my data may be withdrawn at any time by me on notice to DAFM once my participation in this programme has finished. Facilitators will be allowed access to this data for the purpose of the STAP only.

(viii) I understand that successful participation in the 2013 STAP shall not confer an automatic entitlement to payment and that cross-checks will be made by DAFM to ensure that payments made to me in respect of the years 2011, 2012 and 2013 do not exceed the de minimis limit of €7,500.

Signature of Applicant: ______Date: ______

(All applicants must ensure that completed application forms are submitted to their discussion group facilitator by Friday, 15 February 2013.