Maison de l’UPA
555, boul. Roland-Therrien, bureau 505
Longueuil (Québec) J4H 4G4
Telephone :
450 679-0540 (Ext. 8743)
Fax :
450 679-6372
Email : paiementanticipe@pgq.ca
Request form - Advance Payments Program
2015 – 2016 Crop Year
Post-harvest component
Date of reception at our office
December 31, 2015
Producer’s name :
# UPA :
Business name :
# APP - AAC :
Address :
# NIM :
City :
Postal code :
# FADQ :
CELL
PHONE :
Telephone :
E-MAIL :
*Contact name :
FAX :
*Address of the farm if different from mailing address :
1. Producer - For a new participant, please provide us with the complete address, phone number and birth date of each partner or
shareholder.
Name of shareholder/partner
Address of shareholder/partner, if different
than the farm
Date of
Birth
Telephone
% In profits
(losses)
2. Declaration of APP advances received from other producer organizations
You must provide the following information

List all advances issued to you or any Shareholder, member or partner by other organizations for the 2015-2016 production period,
including advances attributed by percentage of participation in any Corporation/Cooperative/Partnership.

If you have a participation in other association, you must complete section 3, otherwise skip to section 4.
Producer’s name
Company name
Telephone
% Participation
Federation/
Organization
Advance
amount
You must also provide the following information

List all outstanding advances issued by any organization for previous program years to you or each shareholder, member or partner of the
business, including advances attributed by percentage of ownership in any Corporation/Partnership/Cooperative.
Producer’s name
Company name
Telephone
% Participation
Federation/
Organization
Unpaid
balance
3. Related Producers. Complete if you have a percentage of participation in any company, otherwise skip to section 4
Producers are related if they do not deal with each other at arm’s length.
In the absence of proof to the contrary, producers are presumed to be related to another producer in any of the following circumstances:

The producer controls, directly or indirectly in any manner, the other producer.

The producer is controlled, directly or indirectly in any manner, by the same person or group of persons as the other producer.

The producer carries on a farming operation in partnership with the other producer.

The producer shares any management and administrative services, equipment, facilities or overhead expenses of a farming operation with
the other producer, but is not in partnership with that other producer; or

Any other circumstances set out in the regulations.
Relatedness affects the applicant’s eligibility to receive an advance, as well as the amount of an advance.

Has a related producer applied for an APP advance in this program year or have an outstanding APP advance?
Yes
No
If yes, complete sections 3.1 et 3.2
3.1 Is any related producer ineligible as a result of a default under APP, SCAP or ESCAP?
Yes
No
3.2 Rebuttal of relatedness: Name of the related producer:
a)
You and the related producer file separate tax returns and/or produce separate financial statements. Yes
No
b)
You and the related producer are not employees or do not act as agents of the other.
No
Yes
c)
You and the related producer conduct all business transactions (e.g. sharing of equipment and/or land) at fair market value and
such transactions are documented.
Yes
No


If you responded “NO” to any of the questions above, you have not rebutted the presumption of relatedness with the producer in
question.
If you responded “YES” to all the statements above, you have established that you deal at arm’s length with the producer in question,
and the Administrator may request the appropriate documentation to support your responses, such as articles of incorporation,
financial statements, leases, receipts, etc.
4. Financial institutions where you do business – Bank or Caisse Desjardins
For a new participant or in case of a modification on your account number, please include a void check.
NAME
ACCOUNT NO.
TRANSIT
NAME
ACCOUNT NO.
TRANSIT
 If there are any lien or encumbrance on your crop or crop-insurance / CAIS (AgriStability) / ASRA in your institution where you
do business, please indicate the information :
Name
Address
Amount
5. Insurance company where you are covered for your farm products
(mandatory in fall for the producers with storage on farm).
Name (Insurance company)

Location of storage : if your crop is stored outside
your farm, please indicate to us the precise location.
Amount (Insured)
Location of storage


and
City
6. Crop to be stored for which you are asking for an advance:
1. Quantity - Make sure the quantities for which you ask an advance for are exact, if not this may cause additional delays in the process of
your application.
2. Hectares - Please indicate the details of cultured hectares for each production declared to the stabilisation insurance (ASRA).
3. Location of storage - Please indicate address of storage facility if different from your postal address :
 Address:
For example : Predetermined rates ($ metric ton) X quantity (metric ton) = Calculated amount
$ 99 (rate) X 100 métric ton (Corn) = $ 9 900
RATES
QUANTITY
 SEE 6. 1
Metric ton
NUMBER
OF HECTARES
 SEE 6. 2
LOCATION OF STORAGE
AT FARM
OR SEE 6.3
CALCULATED
AMOUNT
ADVANCE
AMOUNT
REQUESTED
FEED OATS
$ 113
ha $
$
*SEED OATS
$ 138
ha $
$
**FOOD WHEAT
$ 133
ha $
$
FEED WHEAT
$ 113
ha $
$
*SEED WHEAT
$ 148
ha $
$
CANOLA
$ 207
ha $
$
BEAN
$ 420
ha $
$
FLAX
$ 237
ha $
$
CORN
$ 99
ha $
$
FEED BARLEY
$ 94
ha $
$
*SEED BARLEY
$ 118
ha $
$
DRY PEAS
$ 130
ha $
$
BUCKWHEAT
$ 237
ha $
$
RYE
$ 79
ha $
$
SOYBEANS
$ 207
ha $
$
*SEED SOYBEANS
$ 247
ha $
$
TRITICALE
$ 74
ha $
$
*SEED CROPS - A field inspection report or a grading
certificate must be provided.
**FOOD WHEAT - An official grading must be provided.
TOTAL
AMOUNT
$
$
CRIB
SILO
SHED
IF YOU ASK FOR AN
AMOUNT OVER
$100 000 CHECK OFF
HERE
7. Which designated buyer do you plan on selling your crop to ?
Please indicate a name without obligation on your part of selling to that buyer.
 Name
City
 Name
City
8. Has your grain already been sold YES
NO
Delivery date :
9. Does the quantity for which you are asking an advance represent: 100 % of your crop ? YES
Is your crop stored in a steel silo? YES
NO
Payment date
NO
IF NO - Specify:
NB : Any false statement will be considered a violation of section 37 of the Agricultural Marketing Programs Act (AMPA)
Applicant’s signature
Date
FOR THE USE OF THE FEDERATION ONLY
UNION DUES: ____________________________ RECEIVED ON :_______________________ AGREEMENT MAILED ON:___________________________