| SECTION A |
| General Information |
| 1. Name |
| 2. Address |
| 3. Telephone Number(s) (Work) (Cell) |
| 4. Fax |
| 5. Email |
| 6. Farmer or fisher registration number |
| 7. Identification card number |
| 8. Social Security Number |
| 9. Location of facility/operation |
| 10. Access to land/facility/fishing vessel or boat |
| [ ] Land – Name of land owner |
| Block and Parcel Number |
| Size of property (hectares/acres) |
| Lease Agreement (must be submitted with application) |
| [ ] Facility – Name of land owner |
| [ ] Name of owner of fishing vessel/boat |
| 11. Name of agricultural project (reason for applying for the agricultural or fisheries) incentives |
| SECTION B |
| Information on type of agricultural activity |
| Please specify the type of agricultural activity |
| (a) [ ] crop production | (d) [ ] livestock |
| [ ] banana | [ ] poultry |
| [ ] cocoa | [ ] swine |
| [ ] coconuts | [ ] rabbit |
| [ ] vegetables | [ ] goat |
| [ ] food/root crops | [ ] cattle |
| [ ] fruit/tree crop | [ ] sheep |
| [ ] bees |
| [ ] cut flowers/horticulture | [ ] other |
| [ ] other | |
| (b) [ ] processor |
| (c) [ ] non-timber forest produce | (e) [ ] other |
| SECTION C |
| Information on fishing activity |
| Please specify the type of fishing activity |
| [ ] aquaculture/mariculture | [ ] off shore fishing |
| [ ] near shore fishing | [ ] other |
| [ ] processor |
| SECTION D |
| Existing enterprises |
| 1. Number of years in operation |
| 2. Number of employees |
| 3. Please give an estimate of the sales volume during the previous year |
4. Please give an estimate of the sales value in the previous year
(EC$) |
| 5. Please provide a list of clients/markets |
| Domestic | Regional | International |
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| 6. Please specify any financial resources |
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| SECTION E |
| New enterprise |
| 1. Please attach your business plan to this application. |
| 2. Please specify any financial resources (applicant must attach a copy of any proof to show access to financial resource.) |
| [ ] loan | [ ] if other, specify |
| [ ] cash |
| 3. Please provide a list of potential clients/markets |
| Domestic | Regional | International |
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| 4. Number of employees |
| SECTION F |
| Agriculture and fisheries incentives |
| 1. Please specify the type of agriculture or fisheries incentives requested |
| [ ] exemption from the payment of income tax |
| [ ] exemption from the payment of service charge |
| [ ] exemption from excise tax |
| [ ] exemption import duties |
| [ ] in the case of registered fishers only, fuel rebate (Specify value) |
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| 2. Please specify the item for which agriculture or fisheries incentives are being requested |
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| 3. If applicable, please state the estimated Cost Insurance and Freight (CIF) value |
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| Signature of applicant | Date |