Yes No

APPLICATION FORM FOR MPUMALANGA IDC/UL NGUNI CATTLE DEVELOPMENT

PROJECT 2013/2014

CO-OPERATIVE DETAILS

Co-operative name_________________________________________________________________

Co-operative registration number______________________________________________________

Co-operative representative__________________________________________________________

ID number of co-operative representative________________________________________________

Telephone __________________Cell _______________________Fax________________________

Physical/Business address ______ ___

_________

Postal Address _________

______________________

District ___________________________________________________________________________

Local Municipality __________________________________________________________________

Area name _______________________________________________________________________

Ward Number_____________________________________________________________________

GPS Coordinates___________________________________________________________________

Type of farm: Please tick Own Title Deed Lease

If Lease agreement indicate period of lease in years ______________________________________

PLEASE ATTACH PROOF OF OWNERSHIP

Total land size (ha) ____________Natural grazing (ha) ____________Planted pasture (ha) ________

Arable (ha) ___________and Plantations (ha) _____________

Livestock Brand mark

Yes No Yes No

Yes No No Yes Yes No No Yes

Yes Yes Yes No No No

COOPERATIVE BENEFICIARIES

Total number of beneficiaries in coop__________________

Men____________________________________________

Women _________________________________________

Youth__________________________________________

People living with disability__________________________

AVAILABLE INFRASTRUCTURE: (please cross where applicable)

Boundary fence: Grazing camps

Water sources: River Streams Windmill Borehole

Handling Facilities: Kraals Crush pens Dipping facilities

CURRENT NUMBER OF STOCK ON THE FARM

Cattle: _________ Breeding Bulls: Steers: _______Cows/ Heifers________

Goats: ________________Bucks: Does:

Sheep: ________________Rams Ewes

Pigs: __________________Boars Sows

I hereby declare that the above-mentioned information is true and correct and acknowledge

that any misleading information provided will lead to disqualification.

_____

Signature of Coop representative Date

Witness _______________________ ___________________

Agricultural Advisor Date

Witness _____________________________ ____________________

Agricultural Municipal Manager Date

NB. Project profile must be attached

Office Stamp