PLAS FARMS LEASE APPLICATION FORM - Department Of Agriculture, Land .

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PLAS FARMS LEASE APPLICATION FORM APPLICATION INFORMATION AND CONDITIONS 1. Eligibility Criteria To be eligible to be granted a Land /farm to Lease you must meet the following Eligibility Criteria : (a) Applicant/s must not be employed by the three sphere of government or employees of all public entities prior to the signing of lease, politicians who hold public office, traditional leaders who receives remuneration from the State and permanent residents who are issued permanent residence permits as prescribed into Sec 26 & 27 of Immigration Act, 2002 (Act 13 of 2002). Public servants and their spouses shall not qualify to benefit from agricultural support irrespective of them falling under any of the categories identified above. (b) You must live on the land/ farm following lease approval. (c) The target group for agricultural support which is Africans, Indians and coloureds. (d) Agricultural sciences university and college graduates, (b) Agri-business special courses, including NARYSEC participants and managerial and entrepreneurial incubation, learner ships/internship, and (d) agricultural para-professionals. (e) Subsistence farmers: (a) Communal/village subsistence farmers, (b) Municipal commonage farmers mainly livestock farmers, and sustained homestead garden producers. (f) Further priority, within the target group shall be given to women and the youth who either have basic farming skills or demonstrate a willingness to acquire such skills. Special attention shall be paid to the youth with experience or qualifications in the field of agriculture. (g)“Special category”: (a) Women, including single women,(b) people with disabilities, (c) farm workers/dwellers/tenants ,(d)Military Veterans, as defined in the Military Veterans Act, 2011(Act No.18 of 2011) irrespective of their race, shall also be prioritized. This shall however exclude those who served in the Union Defence Force (prior to 1961) and the South African Defence forces (prior to 27 April 1994) who do not fall under the categories defined (h) Public servants and their spouses shall not qualify to benefit from agricultural support irrespective of them falling under any of the categories identified above 2. Compliance Check A full compliance check of your details provided in this Application for Land Lease and any other information requested and p rovided by you will be undertaken checked for compliance. If you are deemed ineligible: (a) Your application will be rejected (b) If you have provided false or misleading information, DRDLR will terminate Contract. 3. Acceptance or Rejection of Application The Application will be assessed in accordance with the conditions and requirements advertised and may be rejected if: (a) You do not meet the Eligibility Criteria above; or (b) You or your spouse are employed by the state (c) The Application has not been fully completed or executed to the satisfaction of DRDLR 4. Termination of Application A provisional allocation or selection shall cease under the following circumstances: (a) Death of the potential beneficiary (b) Criminal records or conviction (c) Written withdrawal of application by the beneficiary (d) Withdrawal of the farm by the land owners or seller (e) Any other circumstances that the committee may feel justify the termination or withdrawal of the allocation. (f). The land obtained through PLAS should not be sub-let/rented out, if found the Department should take back the land. 5. Documents to be attached to the PLAS application Form 1. SA certified ID copy of applicant & spouse. 2. Proof of residence 3. Certified Legal Entity Registration Certificate (if the applicant is an entity) 4. Schedule of own assets (related to farming) eg. Livestock, farm implements and machinery etc. 5. Copy of marriage certificate (if married) 6. Livestock Branding Certificate 7. Certificate/s of training provided (if any) Cynthia Mahlalela 8. Financial Resources to cover first production Cycle/ to purchase livestock (e.g. proof from the bank). 9. Letter of Authority to[Pick represent the an entity date](if applicant is a legal entity) 10. Tuberculosis (TB) and Brucellosis/Contagious Abortion (CA) certificate for Livestock 11. The applicant/s must provide a written commitment (in the form of affidavit) to pay the lease as per contract terms and also a written commitment to reside on the farm

Date Received Province/District Application reference number Name of official receiving application Signature of applicant All questions contained in this questionnaire are strictly for Official purposes and would be treated confidential Please tick or mark with an X the relevant box APPLICANT DEMOGRAPHIC PROFILE 11.1 What Full Name M F Date of Birth Surname Marital status: Category of Applicant Target Group of Applicant Ethnic Group of Applicant ID Number: Single/never married Cohabitation(living together) Married Separated Divorced Widowed category 1 (Subsistence Farmer) category 2 (Small Scale Farmer) category 3(Medium Scale Farmer) Category 4 ( Large Scale Commercial Farmer) Farm dweller farm worker Labor tenant War Veteran youth Women War Veteran Commonage Farmer NARYSEC/Agricultural Graduate Other Specify African Indian Coloured Spouse Full Name Spouse Employer Spouse ID Spouse contact Details Residential Address: Postal address: Suburb/village Suburb Nearest Town Municipality Postal Code District Province Province Facebook/twitter account Telephone no Cell phone no Fax number Email Address How long have you been living in this address Preferred District/Municipality to Lease 1-2 yrs. 2-4 yrs. 5-9 10 EMPLOYMENT AND EDUCATIONAL DETAILS Occupation: student Pensioner Farmer Farm worker Self Employed Unemployed Internship other Employed in the private Sector Name of Employer Type of Employment Permanent Temporal contract Seasonal Internship/NARYSEC Volunteering other Business activities (self-employed) Sources of Income Salaries, wages, commissions Income from Business Pensions funds Grants(includes old age pension) Sales of Farming products and services Remittances(money received from people living elsewhere) no income other income sources (rental income, interest PLAS FARMS LEASE APPLICATION FORM Page 1

Highest level of Education completed: No Education Primary Matric Secondary N1-N4 N5-N6 National Diploma(Tecknikon/University) Honors Degree Bachelor’s Degree Bachelor’s Degree & Postgraduate Master’s Degree Doctorate Degree Have you received any training related to farming (formal or informal) Yes No Training of Applicant Related to Farming/Agriculture Year Name of Training Institution (formal/ informal) Training of Applicant related to Management (Financial, Marketing and etc) Year Name of Training Institution (formal/ informal) INSTITUTIONAL ARRANGEMENT Are you a member of a group that wants to farm collectively? Yes No M F Size of group Number of Disabled 18-35 yrs. 36-50 yrs. 51-65 yrs. 65-79 yrs. 80 yrs. and above Total Type of Legal Entity: Years of Group entity existence Legal Entity Registration Number Name Surname of Contact Person Postal Address of Entity Communal Property Association other 0-1 year 2-4 Telephone: 5-9 Company Trust Close Cooperation Cooperative Farmers Association 10 Cell: Email: AGRICULTURAL ACTIVITY Are you currently involved in Farming? Yes No Do you pay rent where you farm Yes No Type of Land ownership where you currently Farm Rented Private/Family Farm Communal Land Labor Tenant Farm dweller 0ther (specify) PLAS FARMS LEASE APPLICATION FORM State Land Communal Land (Tribal Land) Page 2

How many years have you been Farming Type of Farming Experience Which Social clubs/ association/organization do you belong to Do you require assistance with the following 1-2 yrs. 2-4 yrs. 5-9 10 Farmers Association Producers Association Special Interest Group other (specify) Cooperatives community Garden Group Development of Business plan Market Access Business Registration Training Management Training other (specify) Mentorship Stokvel Agricultural No of people to be employed by Project? No of employees Does your Household own Livestock/crops: Type of employment SLAG LRAD Name of Grant Income Range received through work, business or farming per month Temporal contract Seasonal Internship Volunteering other Permanent Temporal contract Seasonal Internship Volunteering other Permanent Temporal contract Seasonal Internship Volunteering other Sheep Goat Pigs Chicken Geese other (Specify) veg sugar Cane Pigs Chicken Geese other (Specify) Cattle Grain Type of Animal/Horticulture and Crop Production Previous Grants received from Government: Permanent Number of Livestock/ hectares farmed CASP Restitution Grant Housing Subsidy Government Department Household consumption Sale Household consumption Sale Household consumption Sale Household consumption Sale Household consumption Sale Household consumption Sale Household consumption Sale Household consumption Sale Agricultural Grant other (Specify) Amount Received 0-R199 R200-R499 R500-R1199 R1200-R1799 R1800-R2499 R2500-R4999 R5000-R9999 R10000- above PLAS FARMS LEASE APPLICATION FORM Page 3

What are you intending to use the land for? Agricultural Enterprise Type Grains Tea Crop Production Vegetable Sunflower Sugar cane Nuts Tobacco Other Specify Cotton Grain Viticulture/Vineyards Fruits Herbs Non-food crops (Grass) Horticulture Flowers Medicinal plants Other(specify) Mushrooms Sprouts Beekeeping Beef Ostrich Animal Production Dairy (cows) Poultry (layers) Dairy (Goats) Poultry (Broilers) Goat Aquaculture Main Areas of Interest Primary Production Processing Marketing Interested in Producing for Own Consumption Informal Market Formal Market Sheep Pig Other(specify) List of farm implements (Irrigation Land) What support is needed to help improve your Machinery Implements Production Inputs Infrastructure Finance farming Access to Markets Agricultural Training Other(specify) HOUSEHOLD MEMBER DETAILS (List all persons in your Household, Group Applications, this part must be completed by all Members of the group) HOUSEHOLD REF NO Father Employed(E) Unemployed (U) Mother Employed(E) Unemployed (U) Sibling M F E U M F E U M F E U M F E U M F E U Full ID: Full ID: Full ID: Full ID Full ID Full ID Full ID Name: Name: M F Full Name ID Full Name ID Name: M F Full Name ID Grandmother Employed Unemployed Full Name ID Grandfather Employed Unemployed Full Name ID Grandmother Employed Unemployed Full Name ID Grandfather Employed Unemployed Full Name ID Children/ Gran children Name Maternal Name Maternal Name Paternal Name Paternal F DECLARATION I declare that the information furnished in this applicant form is, to the best of my knowledge, true and correct. I also declare that I am not employed by the public service / not a politician / not a member of the traditional authority remunerated by the State and to the effect that my spouse is not a civil servant and acknowledge that any misrepresentation in this regard constitutes a ground for immediate termination of the agreement. . Signature of applicant . For office use Land parcel Details Farm Name Farm Number Property Type Portion Registration Division LPI Code Hectares/ Extent Province District Municipality Local Municipality Deeds Registry Current Commodity Proposed Commodity Purchase Price Proposed date of Transfer PLAS FARMS LEASE APPLICATION FORM Page 4

Rented Private/Family Farm Communal Land State Land Communal Land (Tribal Land) Labor Tenant Farm dweller 0ther (specify) PLAS FARMS LEASE APPLICATION FORM Page 3 How many years have you been Farming 1-2 yrs. 2-4 yrs. 5-9 10 Type of Farming .

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