X - The Rural Payments Agency - Defra

Only change the information below if the pre-printed information is wrong .CA4Cross todelete lineXXXXXXXXXXCA5Number ofrights of this type.CA6CA7Do youown thecommon?YesNoX X. X XCA8Do you wantto activateentitlements?YesNoX XX XCA9CPH number for this commonC C / P P P / H H H HC C / P P P / H HHH. SAMPLEHX X X X C C / P PP/HHH H. X X X XCC/PPP/HHHH. X X XXCC/PPP/H H H H. XXXXCC/P P P / H H H H. XXXXC C / P P P / H H H H.XXX X C C / P P P / H H H H.X X X X C C / P P P / H H H H. X X X X C C / P P P / H H H HSAMPLECA10YourchecklistX. X X X XC C / P P P / H H H HX. X X X XC C / P P P / H H H HX. X X X XC C / P P P / H H H HF1.20.015V1.20.003V1.20.003P007 007987654321### of ###

Part E:Additional informationE1Special entitlementsIf you do not have any specialentitlements, go straight to E2.Read section D of the SPS HandbookIf you want all of the entitlements you hold that are subject to special conditions toremain as special and not revert to normal entitlements put an ‘X’ in this box.XE2E3Part F:F1HempIf you do not claim forhemp, go straight to E3.Uplands TransitionalPayment (UTP)If you do not farm any SeverelyDisadvantaged Area (SDA) land,including moorland and commonland, that is part of either anEnvironmentally Sensitive Area (ESA)or Countryside Stewardship Scheme(CSS) agreement on1 January 2012, go to Part F.If you have answered yes to E3Amake sure you have filled in details ofyour land in column C11 in Part C.Read section J of the SPS HandbookIf you are growing hemp, how many kilograms will you besowing per hectare? Send your seed labels in with this form.Read section G of the SPS HandbookDo you want to claim UTP?If ‘no’, go straight to Part FHow many eligible cattle will you keep for the 6 month retention period?You can start this period on any day between 1 July and 31 December 2011.How many eligible sheep will you keep for the 100 day retentionperiod? You can start this period on any day between 1 Januaryand 22 September 2011.Give the number of the CSS or ESA agreement.If there is more than one agreement, give thenumber of the agreement that is last to expire.Other documents that you are sendingUse this part to tell uswhich documents youare sending with yourapplication.Stick an SBI barcode label oneach document.If you are sending anbox.If you are sending aIf you are sending anIf you are sending aIf you are sending aform (SP9), put an ‘X’ in this(CReg 01), put an ‘X’ in this box.form (RLE 1), how many are attached?If you are sending maps, including sketch maps, how many?If you are claiming for hemp, how many copies of original official hemp seedlabels have you attached?How many continuation booklets for this form have you attached?How many other documents have you attached?If you are sendingforms for other UKregions, put an ‘X' inthe relevant boxes totell us which region orregions you areapplying for.Northern IrelandYesKg/haXXX Wales X Scotland X.X(SP13), put an ‘X’ in this box.(SP11), put an ‘X’ in this box.SAMPLENoXXXF1.20.015V1.20.006V1.20.006P010010987654321### of ###

Part G:Claim summaryG1 For your own use: This area is for your own use. These totals do not form part of your application. We willuse the information from the Field Data Sheets to work out your claim totals.Total land areaLand outside SDA(EOUT)SDA land non moorland(ESDA)Moorland within SDA(EMOR). ha . ha . haSingle Payment SchemeTotal area claimed for SPS:Other aid schemesProtein:Normal (NML)Special (SPE)Have you completed columns C8 and C9 in Part C, and if you are claiming common land CA8 in Part CA?If these columns are not filled in, we cannot pay you.If you are claiming for Protein or Nuts, have you filled in columns C8 and C11 for these land parcels?If these columns are not filled in, we cannot pay you.If you are claiming for UTP 2012 have you answered the question at Part E3, and haveyou filled in columns C8 and C11 for the relevant land parcels?If you have made any mistakes on this form, have you initialled and dated the corrections?Have you read the declaration and signed and dated the form at Part I?If you have not signed the form, we cannot pay you.Have you attached your maps or other supporting documents?. ha . ha . ha. ha . ha. haUTP: . ha.ha. haNuts: . ha . ha . haG2 Entitlements This is the entitlements information that we have on record for your business. Recent transfersmay not be taken into account. Read section D of the SPS Handbook.Part H:Checklist for your own useLand outside SDA SDA land non moorland Moorland within SDASAMPLESAMPLEhaRemember to check through the notes on the front of this form and put the correct amount of postage on theapplication envelope before sending it to us. Remember to keep a copy of the form and send the original to us.XXXXXXF1.20.015V1.20.008V1.20.008P005 005987654321### of ###

Part I:To receive yourpayment, you mustsign this part toconfirm that youunderstand, agreeand are complyingwith the conditionslisted.If you are signing asan agent or a partnerread section R of theSPS Handbook to seewhether you need tosend an authorisationform (SP9).You must sign and dateyour applicationName:Status:F1.20.015V1.20.007V1.20.007P013 013Your declaration and responsibilitiesRural Payments Agency, PO Box 300, Sheffield, S95 1AACustomer Service Centre: csc@rpa.gsi.gov.uk or 0845 603 7777The Rural Payments Agency is an Executive Agency of the Department for Environment, Food and Rural Affairs (Defra)987654321### of ###WarningsRPA can only pay you if you agree with these conditions and comply with them. If you change thewording of this section in any way, we may reject your application. We may also recover any moneythat we have already paid to you.If you make a false declaration, or if you do not tell us about a material change to the information in thisform, you may be liable to prosecution. A false, inaccurate or incomplete statement or failure to tell usof any material change to the information given in this form, may result in loss of entitlement and/orrecovery of any payments made.DeclarationI confirm that I am a farmer as defined in Article 2(a) of Council Regulation (EC) 73/2009 (as amended),as referred to in section B of the SPS Handbook. I am aware of the conditions that apply to this, myapplication, and I have complied with these conditions.I have told RPA about all the farming business interests held by any members of this business.I have complied with the current versions of:- Council Regulation (EC) 73/2009 (as amended);- Commission Regulations (EC) 1120/2009 (as amended), (EC) 1122/2009 (as amended), and(EC) 1121/2009 (as amended) implementing this Council regulation; and- any other applicable legislation.I have read and understood all of the relevant guidance information, and confirm that the details givenon this application, including:- the Entitlements Statement;- any (SP11);- any continuation booklets; and- any supporting documentsare true, accurate and completed to the best of my knowledge and belief.If there is any material change to the information in this application, I will tell RPA.I confirm that the land in this application is at my disposal on 16 May 2011.If I am applying for Uplands Transitional Payment 2012:- I will comply with the relevant parts of Council Regulations (EC) 1257/1999 and (EC) 1698/2005 (asamended);- I have read and understood theexplanatory booklet;- I will pursue my farming activity in a Less Favoured Area (LFA) (as explained in theexplanatory booklet) for at least five years from the first payment of LFAsupport.I confirm that this application supersedes any previous application made by me for the Single Paymentin 2011, and that any such previous application is hereby withdrawn.for example, agent, partner, owner, director, sole trader.Data protectionD D / M M / Y Y Y YSAMPLEAll RPA payments must be made directly into your bank account. If you have notgiven us your bank details, we will not be able to pay you.Defra is the data controller for any personal data that you give to the Rural Payments Agency. Yourpersonal information will be protected in line with the Data Protection Act 1998. We will use the datamainly to support the application it relates to. We may also use it in line with the Data Protection Act, forother purposes as we explain in scheme guidance and on the Access to Information pages on ourwebsite: http://www.rpa.gov.uk/rpa/index.nsf/home, then put 'Access to Information' into the searchbox. If you have any questions on our Data Protection policy please telephone our Customer ServiceCentre.