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

COOPERATIVE BENEFICIARIES
Total number of beneficiaries in coop__________________
Men____________________________________________
Women _________________________________________
Youth__________________________________________
People living with disability__________________________
AVAILABLE INFRASTRUCTURE: (please cross where applicable)
Boundary fence:

Yes

Grazing camps

No

Water sources: River Yes

Handling Facilities: Kraals Yes

No

Yes

Streams Yes
No

Crush pens

No
No
Yes

Windmill
No

Yes

No

Borehole

Dipping facilities

Yes

Yes
No

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

No