(Regulation 20) |
FORM I |
–––––– |
RETURN CLAIMING BENEFIT. |
ISLAND OF......................................... |
1. | Name(s) of grower(s) ........................................................................... |
| ........................................................................................................... |
2. | Address(es) of Grower(s) ...................................................................... |
| ........................................................................................................... |
3. | Registration number of affected holding .................................................. |
4. | Date of windstorm ................................................................................ |
5. | Name and location of holding ................................................................. |
| Ratoon Mats | Plant Mats |
(Statutory Insurance) | (Contractual Insurance) |
Date of planting .............................................................................................. |
Acreage under cultivation ................................................................................ |
Number immediately before windstorm ............................................................. |
No. destroyed or affected ................................................................................ |
Detail the above information according to fields or sections at the back of this form. |
State boundaries of holding: |
NORTH ....................................................................................................... |
SOUTH ....................................................................................................... |
EAST ......................................................................................................... |
WEST ......................................................................................................... |
Other Holdings Under Your Control: (This only applies to Statutorily Insured Ratoon Mats) |
Are you in possession or control of any other holding or holdings ............................. |
If so, how many ............................................................................................... |
Give particulars of other holdings on the back of this form |
Are the sales of bunches from this holding kept separate and distinct from sales of bunches from any other holding or holdings .............................................. |
.................................................................................................................. |
If so state names and registration numbers of other holding or holdings |
....................................................................................... |
I/We, do hereby make return claiming benefit in respect of the loss of my/our ratoon plant mats occasioned by the aforesaid windstorm and do hereby declare that the above return is true and correct to the best of my/our knowledge and belief. |
(Signed) ....................................... |
Witness ....................................... |