| 1. Declaration year |
| 2. Please indicate an estimate of the total sales during assessment year |
| |
| |
| 3. Please indicate the value of inputs for the assessment year |
| 4. Please indicate any technical assistance received from the Ministry responsible for agriculture and fisheries |
| [ ] extension services |
| [ ] formal training |
| [ ] invitation and participation in workshops, seminars and other meetings |
| 5. Certification |
| [ ] Global – GAP |
| [ ] other |
| |
| I hereby declare that the information provided is accurate and I understand that the information provided will be kept in the strictest of confidence by the Ministry responsible for agriculture and fisheries. |
| I also understand that deliberate submission of false information can potentially result in revocation of any agriculture and fisheries incentives granted under the Agriculture and Fisheries Incentives Act. |
| | |
| Signature of declarant | Signature of receiving officer |
| Date | Date |