QSP 02
DEPARTMENT OF AGRICULTURE AND FOOD
Quality Stallion Purchase Incentive Scheme
Application Form
All sections of this form must be fully and accurately completed. Where applicable write “None”.
PLEASE USE BLOCK CAPITALS THROUGHOUT
D.O.B.
1.
Name of Applicant(s)
PPS No.
(Mr./Mrs./Ms.)
(Applicants)
Name of Manager
Herd No.
(Responsible for Stallion)
(Applicants)
3.
Address
Phone No.
Mobile No.
Fax No.
4.
County
5.
What is your main occupation?
2.
Telephone Numbers
*If application is being made by a Company, Society or other Partnership group, please give full legal
title of the person or organisation with beneficial ownership under “APPLICANT” and name the
Manager who will be responsible for keeping and managing the stallion and all further particulars
should relate chiefly to that person (see paragraph 1 of PART II of the documentation)
For Official Use Only
File No. …………………….
Date rec’d. …………………
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Date Approved
3rd June 2003
Location of Stud
6.
Give full description including address (if different to above) of location of stud
7.
Will this stallion be used to service mares in Northern Ireland?
8.
If yes, approximately what percentage of the mares would you expect to be based in
Y/N
Northern Ireland?
Facilities
9.
Describe the facilities available to you for keeping the stallion and mares for servicing.
Existing Stallions
10.
Indicate the Stallions currently standing at stud at your farm together with the number of coverings
per stallion per year.
Experience
11.
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Describe the experience and/or training you have in the field of stud farming
Date Approved
3rd June 2003
Declaration
I/We certify that the above information is correct. I/We have read and understand the conditions of the
Quality Stallion Purchase Incentive Scheme contained in Parts I, II and III of the documentation on the
Scheme and agree to observe and be bound by those conditions and any other conditions which the Minister
may apply to the scheme of which I/We may be notified and to make available all required information to
the Minister for Agriculture and Food.
I/We hereby apply to be considered for grant aid under the “Quality Stallion Purchase Incentive Scheme”.
Signed:
Date:
Signed:
Date:
Signed:
Date:
N.B.
A false or misleading statement may lead to disqualification, liability to refund any premium
given and prosecution.
This Scheme is funded by the Irish Government under the
National Development Plan 2000-2006
Send completed application to:Livestock Breeding Division (Horses)
Department of Agriculture and Food
Government Building
Farnham Street
Cavan
DATA PROTECTION ACT
The Department of Agriculture and Food will treat all information provided to it as confidential and
will not disclose such information except as permitted by you or as required by law. The information
provided will be held on computer and will be used only for the purposes registered under the Data
Protection Act.
FREEDOM OF INFORMATION ACT
The Department is subject to the provisions of the Freedom of Information (FOI) Act. If an applicant
considers that any of the information to be supplied is either commercially sensitive or confidential in
nature, this should be highlighted and the reasons for its sensitivity specified. In such cases, the
relevant material will, in response to FOI requests, be examined in the light of the exemptions
provided for in the FOI Act.
3 of 3
Date Approved
3rd June 2003
DEPARTMENT OF AGRICULTURE AND FOOD
If your application is successful your bank details will be required so that the grant payment may be made to
you. Please complete the following form.
Payment of QSPIS Grant Aid directly into a Bank Account
First Name
Surname
I/We hereby authorise the Department of Agriculture and Food to pay the grant aid due to me/us under the
above Scheme into a bank account, details of which are set out below.
For joint applications all applicants must sign below.
Signed:
Date:
Signed:
Date:
Signed:
Date:
Bank Account Details
Bank Account No.
Bank Sort Code
Please ensure that the Account No.
is complete and correct.
Bank Account Name
Bank Name
Bank Branch Address
4 of 4
Date Approved
3rd June 2003
The Bank Sort Code is available
from your bank.
Please ensure that it is correct.