SCOTTISH QUALITY WILD VENISON ASSURANCE SCHEME
APPLICATION FORM
The undernoted wishes to apply for registration under the Acoura Certification Scheme operated on behalf of Scottish Quality Wild Venison (SQWV). /

Are you a member of any other Farm Assurance Scheme(s)? If so, please advise your membership number:-

QMS Cattle & SheepOther

APPLICATION FOR MEMBERSHIP(please indicate your appropriate membership):

Estate/Farmer ☐Processor/Game Dealer ☐

Please advise number of carcases sold per annum:- _____

Species Breakdown (please advisethe number of carcases sold per annum for each species):

Red / Roe / Fallow / Sika
Correspondence Details: (please input the name and address you wish scheme documentation to be sent to)
Company Name: / Contact Name:
Address & Postcode:
Tel. No: / Fax No:
E-mail address:

Additional Sites: (if applicable)

(including details of Estate addresses and/or Lead Stalker contact details, if different from the above details)

Address 1:
Contact Name: / Contact Tel No:
Address 2:
Contact Name: / Contact Tel No:

MEMBERSHIP FEE:

Please tick appropriate box and enclose payment with this form. (Producer membership covers an annual membership fee and 1 assessment fee). Cheques should be made payable to SQWV.

Any subsequent assessment fees for additional sites will be invoiced to your Company prior to assessment.

Producer

Number of carcases sold per year:

1 – 25 £68 + VAT = £81.60

26 – 50 £100 + VAT = £120.00

51 – 100 £182 + VAT = £218.40
101 – 200 £288 + VAT = £345.60
201 – 500 £386 + VAT = £463.20
501 – 1000 £456 + VAT = £547.20
1001 + £497 + VAT = £596.40 /

Processor

An Annual fee of £174 + VAT = £208.80 plus up to 2 inspections per year @ £497.00 + VAT = £596.40 per inspection.

The Annual fee + first inspection fee are due on application (£671.00 + VAT = £805.20).

A new applicant can have apre assessment for a fee of £155 + VAT = £186.

ADDITIONAL INFORMATION (relevant to application):

Does Acoura currently provide you with any other services or certification?

If so, please provide details

It is a condition of the Scheme that all applicants must sign the following declaration that they will abide by the terms of the Scheme.

DECLARATION

I (the undersigned) have read the requirements which pertain to the Acoura Certification Scheme operated on behalf of SQWV. I am fully responsible for the operation of the business at the site(s) declared and I hereby wish to apply to join the SQWV scheme.

If accepted, I agree to abide by the conditions of membership as detailed in the Acoura Scheme Regulations and SQWV scheme standards.

I declare that I KNOW/DO NOT KNOW (please delete as appropriate) of any past (within the last 5 years)/pending/current prosecutions relating to my business at time of applying for membership of the scheme. Details of prosecutions within the last 5 years must be given below:

…………………………………………………………………………………………………………………………………….

I agree to abide by the terms of the scheme and undertake to inform Acoura immediately if, for whatever reason, the requirements of the scheme can no longer be conformed to.

I understand and agree that as a member of the SQWV Assurance Scheme my membership details will be circulated to Processor members and may be listed on the SQWV website or circulated to other relevant parties.

I agree to the site(s) listed above being assessed by an Acoura assessor appointed to the scheme.

I declare that the information given on this form is correct.

Signature:Name:

Position:Date:

Application form should be returned to SQWV Scheme Manager, Acoura, 6 Redheughs Rigg, Edinburgh, EH12 9DQ

Tel. 0131 335 6603 Fax. 0131 335 6601.

Application review carried out by / Date / Undertake requested certification work (if No, record reason)
Yes / No

SQWV Application form Issue 12, 01/2016