Annex 1 Forestry Commission Annual Claim Form Important: This Claim Form (all pages including this page) and any applicable supporting documents (such as a new Agent Authority Form) must be signed and returned using the enclosed self-addressed envelope, to be received by 15 June 2015. To help you answer any questions we have created an FAQ. Please see Annex 2. If for any reason you are late in returning it, or fail to return it, your annual payment may incur a penalty or be withheld completely for this year (2015). If you want confirmation that your Claim Form has been received, please tick this box: Do not detach the slip below – Forestry Commission use only ----------------------------------------------------------------------------------------------------- Claim Form Acknowledgement GLOS Case Ref: PLEASE REFER TO LETTER RECEIVED Agreement Ref: PLEASE REFER TO LETTER RECEIVED Property Name: PLEASE REFER TO LETTER RECEIVED SBI: PLEASE REFER TO LETTER RECEIVED Your Claim Form was received by the Forestry Commission on the date shown below. This acknowledgement only provides proof that your form has been received by the Forestry Commission. Recipient name and address Forestry Commission date stamp PLEASE REFER TO LETTER RECEIVED Page 1 How to complete this form Please complete this form by hand, using block letters and black ink throughout. Please ensure that you complete all relevant sections of this form, including any applicable tick boxes and that you sign and date it. Failure to complete and return the Claim Form in time for it to be received by the 15 June deadline may result in a penalty to your annual claim for this year. If you require more space for any section please continue on a separate sheet, ensuring that you add your Forestry Commission claim details as referenced below. Section 1: Your claim details GLOS Case Ref: PLEASE REFER TO LETTER RECEIVED Property Name: PLEASE REFER TO LETTER RECEIVED Agreement Ref: PLEASE REFER TO LETTER RECEIVED SBI: PLEASE REFER TO LETTER RECEIVED ----------------------------------------------------------------------------------------------------------- This space is intentionally left blank for the reverse of the acknowledgement Do not write anything here Page 2 Section 2: Receiving future updates Email alerts highlight new information relevant to Grants and Regulations customers. If you are interested in receiving these, please tick the box and provide your email address below. Recipient’s email address: Section 3: Change(s) to your claim If any of the details of your agreement have changed, e.g. you have been/will be unable to carry out the management required or there has been a transfer in or out of land which has not yet been notified to the Forestry Commission, please provide an explanation in the box below. Please use the box below as follows: To explain why you have been/will be unable to carry out the management required. Please include details of work areas affected. To provide details of any transfers in/out of your agreement (e.g. details of the land, the party the land was transferred to/from and the date of transfer). Please refer to the Successor Form Operations Note 14 guidance on our Forestry Commission website. http://www.forestry.gov.uk/forestry/infd-7tyffe To provide details of any other changes. Page 3 (Section 3 Continued) Please record the number of continuation sheets used in the box. Please ensure that each sheet includes your claim reference, signature and date. Page 4 Section 4: Declarations You must tick all the declarations in the table below. If you are unable to tick all the declarations you should explain why in section 3, but this may result in some or all of your payment being withheld. I declare that: a) I have complied with and will continue to comply with the provisions of my agreement and the rules of the scheme as set out in my contract and supplements (if any) until my agreement ends. If following submission of this claim form I am unable to fulfill the obligations of my agreement I will notify the Forestry Commission. b) I accept the conditions of payment and understand that payment may be withheld or recovered if it appears to the Forestry Commission that any of the conditions have not been complied with or a false or misleading statement has been made. c) As an agreement holder you must register on the online Rural Payments service. Further details can be found at www.gov.uk/rural-payments d) As an agreement holder the land you manage must be fully registered. You can check this using the maps the Rural Payments Agency send you. e) I confirm that I have registered on the new online Rural Payments service. I confirm that all of the land details for the holding(s) that I manage, including all land subject to a Common Agricultural Policy (CAP) agreement, are correct at the date of submitting this declaration, or I have notified the Rural Payments Agency of any corrections required via an RLE1 form. The details I have provided on this form are correct and I accept full responsibility for them. Page 5 Section 5: Agent Authorisation (For completion by agents only) Please note that the Agent Authority Form has changed, therefore if you are an agent acting on behalf of the agreement holder you will need to submit a new Forestry Commission Agent Authority Form. The Agent Authority Form is available from the Forestry Commission Grants and Regulations homepage http://www.forestry.gov.uk/england-grants You must tick all the declarations in the table below. I declare that: a) b) I am authorised to act as an Agreement Management Agent for this agreement. I confirm that I have drawn to the attention of the beneficiary(s) the conditions that apply to this claim and I have made the beneficiary(s) aware that they are responsible for complying with those conditions. I have enclosed a new Agent Authority Form. As an agent you must register on the online Rural Payments service. Further details can be found at www.gov.uk/rural-payments I have registered on the new online Rural Payments service. Page 6 Section 6: Signature and date Please sign and date this Claim Form. This Claim Form must be signed by either the agreement holder or by an agent who has written authority from the named agreement holder (as per Section 5). Signature Name Status (e.g. agent) Agreement holder CRN (to be completed on all Claim Forms) Agent CRN (to be completed only when an agent has signed this Claim Form) Date Section 7: Return document check Note: Only agents need to complete section b) below. Please confirm you have enclosed the following documents: a) I confirm that I have enclosed the completed Claim Form (Annex 1) b) I confirm that I have enclosed a new Agent Authority Form (agents only) Please return the above documents in the enclosed self-addressed envelope. Page 7 Warning If you knowingly or recklessly make a false statement to obtain aid for yourself or anyone else, you risk prosecution (which could result in imprisonment, a fine or both), the loss of all aid paid to you under the scheme(s) in respect of which you have made a commitment, and exclusion from certain schemes for up to two years. Using and sharing your information The data controller is the Forestry Commission, 620 Bristol Business Park, Coldharbour Lane, Bristol BS16 1EJ. Your information will be stored and processed in accordance with the Data Protection Act 1998. This Act gives you, as an individual, the right to know what data we hold on you, how we use it, with whom we share it and to ensure that it is accurate. We will use the data for administering and analysing agreements and claims under the English Woodland Grant Scheme (EWGS), Woodland Grant Scheme 1, 2 and 3 (WGS), Farm Woodland Premium Scheme (FWPS) and Farm Woodland Scheme (FWS), Felling Licence Agreements and Forest Plans (England). We will circulate and discuss it, in confidence, with those persons or organisations helping us to assess and monitor agreements and claims. Some information will be shared with other grant distribution bodies and government departments, to enable them to detect fraudulent applications, agreements and claims and to co-ordinate the processing of complementary applications, agreements and claims. To do this, we may have to discuss applications, agreements and claims with third parties or disclose information about funding decisions. Participation in the English Woodland Grant Scheme (EWGS), Woodland Grant Scheme (WGS), Farm Woodland Premium Scheme (FWPS) and Farm Woodland Scheme (FWS) involves expenditure of public money and is therefore a matter of public interest. We, or our appointed agents, may use the name, address and other details on your application form to contact you in connection with customer research aimed at improving the services that we provide to you. We will respect personal privacy while complying with access to information requests to the extent necessary to enable the Forestry Commission to comply with its statutory obligations under the Environmental Information Regulations 2004 and the Freedom of Information Act 2000. Page 8