Application Form – Extensive farming systems only

I hereby apply to be admitted to the Rural Environmental Protection Scheme

PERSONAL DETAILS SECTION (BLOCK CAPITALS ONLY)

First Names of Applicant / Personal Public Service No (PPSN)
J / O / S / E / P / H / 1 / 2 / 3 / 4 / 5 / 6 / 7 / T
Surname of Applicant / Date of Birth
B / L / O / G / G / S / 2 / 0 / _ / 0 / 2 / _ / 6 / 4
Address / Telephone number
B / A / L / L / Y / D / U / F / F / 0 / 5 / 4 / 1 / 2 / 3 / 4 / 5
B / U / N / C / L / O / D / Y / Mobile number
C / O / W / E / X / F / O / R / D / 0 / 8 / 5 / 1 / 2 / 3 / 4 / 5 / 6 / 7
Herd no./Area Aid no. / A / 1 / 2 / 3 / 4 / 5 / 6 / 7 / Existing or Previous REPS no. / 1 / 0 / A / 0 / 5 / 5 / 5 / 5
Name / Code
Name & Code of River/Tributary Catchment / Clodey / 12C03
National Heritage Area (NHA) / Rosslare Sandhills / 00737
Special Area of Conservation (SAC)
/Special Protection Area (SPA) / Wexford Nature Reserve / 00001
Commonage / Craan / WX02A/E/CW01F

Declaration of all Lands Farmed Subject to this Application

Land Parcel Number
(LPIS No) / If applicable state the share of commonage/ grazing right / Gross Area of Parcel *
(LPIS Area)
(Ha) / Deductions as per Scheme Document / Land
Designation
** / Contract Area
Net
Non Target Area (Ha) / Net
Target Area (Ha)
A11515091 / 3.01 / O / 3.01
A11515105 / 2.51 / O / 2.51
A11516121 / 7.39 / O / 7.39
A11614639 / 8.31 / 0.20 / O / 8.11
A11614640 / 5.27 / O / 5.27
A11515068 / 1.02 / L / 1.02
A11515095 / 5.00 / 0.38 / L / 4.62
A11515107 / 3.51 / O T / 2.25 / 1.26
A11515108 / 1/3 / 0.38 / C / 0.38
A11515109 / 1/24 / 2.64 / C / 2.64
A11515110 / 1/4 / 3.62 / 3.62 / IC
A11515112 / 4.62 / 4.62 / R
A11515113 / 3.20 / 3.20 / R
A11515134 / 4.62 / 4.62 / F
Total from 2a
TOTAL AREA FARMED / A 50.10
B 34.18 / C 4.28
TOTAL AREA ELIGIBLE FOR PAYMENT (B + C) / D 38.46
Owned Land Let/Leased to Others / 3.2 Ha

* In the case of commonages or grazing rights this figure is the gross area of the farmers share

** Land Designation O = Owned L = Leased C = Commonage T =Target Land (SAC, SPA, NHA) IC= Non Eligible Commonage R=Rented In Short Term F=Forestry S=Setaside

Net
Owned / Net Leased / Net Commonage/Grazing Rights / Net
Non-commonage Target / Net Ineligible commonage/Grazing Rights / Net
Rented
In / Net
Forestry
28.54 / 5.64 / 3.02 / 1.26 / 3.62 / 7.82 / 4.62
Supplementary Measures Claimed / SM3 /
SM4*
/ SM6
Tick Box or enter area* / Ha

DECLARATION : (must be signed by each applicant)

(i)  My/Our average planned stocking density including all grazing livestock will be less than 1.4 LU per hectare and my/our actual stocking density will not increase by more than 10% or 2 LU, whichever is the higher above the planned levels during the contract period.

(ii)  Including all grazing livestock my/our average planned number of LU will not exceed 60 LU in any recording year of the contract period.

(iii)  My/Our total tillage area will be less than or equal to 5 hectares during the contract period.

(iv)  The information furnished to the planner and recorded in the accompanying plan is correct.

(v)  I/We have read and agree to observe and be bound by the terms and conditions of the Rural Environment Protection Scheme, and understand that failure to comply with my Agri-Environmental plan may lead to the imposition of penalties.

(vi)  I/We have read and understand the Department’s Agri-environmental Specifications.

(vii)  I/We hereby undertake to carry out my/our farming activities in accordance with my/our Agri-environmental Plan and the Department’s Agri-environmental Specifications.

(viii)  I/We accept that the pre-printed forms issued by the Department for second and subsequent payments are provided as a service to applicants and the onus of responsibility rests with the beneficiary to ensure applications are lodged within the specified time frame.

(ix)  I/We have read and understand the conditions that apply to the disposal of land during the 5-year contract.

(x)  I/We understand that a fraudulent declaration of the eligible lands farmed will result in disqualification from the scheme. The Department will seek a full refund of all payments made under the scheme.

Signed ...... ……....……… Date ...... …… 20 ......

(applicant)

Signed ...... ……....……… .. Date ...... …. 20 ...... ….

(joint applications only)

Signed ...... ……....……… .. Date ...... …. 20 ...... ….

(joint applications only)

Note: A false or misleading statement may lead to disqualification and/or liability to refund any payments

obtained and possible prosecution.

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.

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PERSONAL DETAILS SECTION (for joint applicants)

(BLOCK CAPITALS ONLY)

First Names of Partner 1 / Personal Public Service No (PPSN)
Surname of Partner 1 / Date of Birth
_ / _
Address / Telephone number
Mobile number
Herd no./Area Aid no. / Existing or Previous REPS no.
First Names of Partner 2 / Personal Public Service No (PPSN)
Surname of Partner 2 / Date of Birth
_ / _
Address / Telephone number
Mobile number
Herd no./Area Aid no. / Existing or Previous REPS no.

Note – Joint applicants listed above must also sign page 3 of the application

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