`` KENYA SEED COMPANY LIMITED
P.O. Box 553, KITALE, KENYA
Tel: 054 – 31909/14 Fax: 254 – 325 – 20458 / 30385
E-mail address: OR
APPLICATION FORM FOR CONTRACT SEED MAIZE GROWING
2018/ 2019
1. Full name of applicant: ………………………………………………..
2. Postal address: ………………………………………………………..
3. Telephone: …………………………E-mail address: ………………..
4. ID No. (Attach copy)……………………………………………………
5. Farm on which crop will be grown: ......
6. L.R. No of the farm: ..…………………………………………………
7. Gender: Male Female Age: 18-35 yrs 35 – 50 yrs 50 – 100 yrs
8. The field sizes and previous cropping history of the fields for which I wish to apply for maize production are as follows:-
Possible FieldNo. / Acres (Ha.) / Previous Cropping History
2013 / 2014 / 2015 / 2016 / 2017
9. Are fields protected against intrusion by wild game or livestock?
…………….
10. Are fields readily accessible, even in wet weather? ………………and if so, indicate the distance from the farm to Seed Dries (Kms) ………………………
11. The person who will be daily responsible for the growing activities is
Name: ……………………………Tel: …………….……Position: ……………..
12. Do you own machinery and finances for all operations? ……………….
If not how do you intend to carry out and finance growing activities?
……………………………………………………………………………
13. That I will provide an isolation distance of at least 200 metres from Non Seed Maize Crop and 8 guard rows (male) all round the field.
……………………………………………………………………………
14. I will follow all seed maize production rules as stipulated in The Seed and Plant Varieties Act. CAP 326 (Rules & Regulations) …………………..
NOTE:
a) Attach copies of Land Registration Certificate or Lease Agreement
b) This application is NOT a Confirmation of Allocation.
Attach a farm map, sketch map or draw a route to the farm on the space
below:
Grower’s Signature: ………………………. Date: ……………………
Field Officer’s Evaluation
INDICATOR / IDEAL STATUS / OBSERVATION / REMARKSIsolation Distance / 200M
Acreage Applied / Accurate
Field Accessibility / Accessible
Protection against intrusion / Protected
Distance to Seed Driers / KMs
Based on the preliminary assessment, and the field visit carried out on ………….……. (Date) I consider this applicant suitable/unsuitable for seed growing. (Delete whichever is inapplicable)
Name: ………………………………. Signature: ………………. Date: …………
Production Manager - Seed Maize recommendations:
………………………………………………………………………………………
………………………………………………………………………………………
Name: …………………… Signature: ………………. Date: …… ……………
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