2015 Year-end Report and Claim Form

Transcription

1 This form is required to consider your operation for a possible AgriStability payment. Section A: Customer information 2015 Year-end Report and Claim Form AgriStability Business name: Civic number and road name: City/Town, province, postal code: Primary business phone number: AgriStability PIN: Business structure: Business number (BN): Corporate structure (if a corporation) Shareholder name AgriStability PIN Percentage owned Farming operation(s) Submit a separate Year-end Report and Claim Form for each business where all aspects of the farm operations (e.g., accounting, bank accounts, income tax filing, crop harvest and storage) are completely separate. Each partner must submit a separate form, except for Sections C and D. For Sections C and D, report information once for the whole farm at 100 per cent ownership. Farm name Your partner name(s) Your Percentage owned Method of accounting Fiscal year-end Section B: Profile questions Answer the following questions as they relate to the 2015 program year. Provide details about your answers to the following questions in the Notes field at the end of this section. For timely processing, please ensure your information is complete. 1. Did you complete six months of farming activities, including a production cycle, and incur allowable expenses in the program year? Yes No 2. Was your operation affected by significant changes or circumstances in the program year? (check all that apply) Downsizing Expansion Large-scale breeding stock replacement Other (please describe in Notes) Change in commodities Change in ownership Disaster or disease 3. Did you, your spouse or another member of your operation have an ownership interest in any other farm or agriculture-related business in the program year? Yes No 4. Did your operation have any transactions with related or non-arm s length parties in the program year? (check all that apply) Joint ventures Income splitting Transactions not at fair market value Group purchasing Other (please describe in Notes) 2015 Year-end Report and Claim Form AgriStability Version française disponible Page 1 of 7

2 5. Was your operation involved in value-added processing or commodity resales in the program year? (check all that apply) Marketing agricultural inputs (feed, seed) Operating a grain elevator Farm-gate retail Other (please describe in Notes) 6. Was your operation involved in any of the following in the program year? (check all that apply) Member of feeder cattle cooperative Contract feeding Custom feeding livestock Sharecropping as landlord Sharecropping as tenant Production outside Ontario Custom feeding arrangements Type of custom-fed livestock Unit (head) Number fed Price received per lb. Total lb. gained Owner of custom-fed livestock Sharecropping arrangements Crop Total or yield Percentage of or yield Your share Percentage of input costs Notes Provide details about the answers you gave above. For timely processing, please ensure your information is complete Year-end Report and Claim Form AgriStability Page 2 of 7

3 Section C: Production and sales Each partner must submit a separate Year-end Report and Claim Form, except for Sections C and D. For these sections, report information once for the whole farm at 100 per cent ownership. Report information as it relates to the 2015 program year. Crop report Did you grow or sell any crops in the program year? Yes No Acreage (square feet for greenhouses) Production and sales (e.g. bu., tonnes) Crop Unit Total Acres for sale Acres for feed Production unit Total produced Quantity sold New and non-bearing Unseeded Pasture Livestock report Did you have livestock in the program year? Yes No Breeding livestock Did you have breeding livestock in the program year? Yes No Type of breeding female Number that birthed (head) Number of live births (head) Purchases of breeding and market livestock Did you buy livestock in the program year? Yes No Type of purchased livestock (by weight category) Unit Number purchased 2015 Year-end Report and Claim Form AgriStability Page 3 of 7

4 Sales of breeding and marketed livestock Did you sell livestock in the program year? Yes No Type of livestock sold (by weight category) Unit Number sold Section D: Year-end inventories Provide a complete inventory of all crops, livestock and inputs like feed and seed on hand at the end of Crop inventory at year-end Did you have crops in inventory at the end of the program year? Yes No Crop Unit Year-end inventory Livestock inventory at year-end: breeding and market animals Did you own livestock at the end of the program year? Yes No Type of livestock (by weight category) Unit Year-end inventory 2015 Year-end Report and Claim Form AgriStability Page 4 of 7

5 Purchased inputs and crops-in-ground Do you have purchased inputs or crops-in-ground to report? Yes No Purchased inputs include items like seed, fertilizer, feed, fuel and other prepaid expenses. For crops-in-ground, which were not mature at the end of your fiscal year, report the dollar value of the associated inputs. Year-end amount Type of purchased input or crop-in-ground ($) Accounts receivable Do you have accounts receivable for allowable income to report? Yes No Account receivable Year-end amount ($) Accounts payable Do you have accounts payable for allowable expenses to report? Yes No Account payable Year-end amount ($) 2015 Year-end Report and Claim Form AgriStability Page 5 of 7

6 Farm Name: Section E: Authorized contacts on file for AgriStability For timely processing, ensure your authorized contacts (e.g., agents) are up to date. To update your authorized contacts, please contact Agricorp or sign in to agricorp.com as soon as possible. The form used to change your authorized contacts also specifies what actions each type of contact is authorized to do on your behalf. Section F: Agreement and signature You must sign this declaration to confirm you understand and agree to abide by the terms and conditions of the AgriStability program as set out below and in the AgriStability Program Guidelines, which are available on agricorp.com or on request. This declaration also allows Agricorp to access your AgriStability program information and to share it with other organizations for specific purposes, which are defined below. If you don t sign and submit this declaration, you could lose potential payments under the program or delay their processing. You can submit it to Agricorp by mail, fax, or or online by signing into agricorp.com. The division of this declaration into sections and the insertion of headings are for convenience of reference only and are not to affect the interpretation of this declaration. Attention agents and other authorized contacts: if you are an authorized representative submitting this form on behalf of the participant, you must review with and obtain the participant s agreement to these terms and conditions, as well as the contents of this form. For purposes of this declaration, I refers to the participant. I certify that: General 1. I meet the eligibility requirements set out in the program guidelines. 2. I remain bound by the terms and conditions set out in the original AgriStability participant declaration that I signed when I first joined the program and to the terms and conditions of this declaration, subject to amendments that Agricorp may make from time to time. By participating in AgriStability or in future similar farm income stabilization/disaster programs administered by Agricorp, I am deemed to have accepted these terms and conditions. 3. I certify that all information submitted on this form and provided to Agricorp under the program is complete, accurate and not misleading. I also understand and acknowledge that I have an obligation to ensure that all information provided to Agricorp by my authorized representatives or any other party on my behalf is complete, accurate and not misleading. 4. I agree that any information provided to Agricorp under the program may be confirmed with the Canada Revenue Agency. I will promptly notify Agricorp in writing of any changes to information provided to Agricorp or to the Canada Revenue Agency. 5. I will not provide any information that is false or misleading in this form, in my AgriStability application or in supporting documents. If Agricorp determines, in its absolute discretion, that I have provided false or misleading information under the AgriStability program, I may be denied current and future participation in the AgriStability program for up to two additional program years, and be denied payment of, or required to repay, any AgriStability payments I have received based on that information. 6. I will not purposely alter my farm s ownership, business structure, size of operation, farming practices, type of farming activity, accounting methods or any other activity or practice, in order to be eligible for, or to increase an AgriStability payment. 7. My main farmstead is in Ontario, and I will disclose to Agricorp any farming activities conducted by me outside of Ontario. Record-keeping and access to information 8. I will keep and provide to Agricorp immediately upon demand all documents and records of every kind whatsoever relating to my farming activities and operations for the program year(s) for which I apply for payments and also for a period of 10 consecutive years prior to those program years. I will allow access to Agricorp and its representatives to the farm and to my farm records, including without limitation, the financial and production records, for verification or audit purposes. I will also provide access to Agricorp to information held directly by third parties including, but not limited to, insurance companies, banks, trust companies, other financial institutions and marketing boards, and I will promptly execute any consent or similar forms that any third party may require before providing Agricorp such access. I understand and agree that any failure, refusal or neglect to provide information or access to information to Agricorp may result in a denial of payments or a requirement to repay any received. 9. I acknowledge that further farm income tax records relating to the reference or program years may be required as part of an audit for further verification, and that AgriStability and income tax records must be consistent for me to be eligible for AgriStability. 10. I will provide information to Agricorp on all farming activities in which I am involved (e.g., sole proprietorships, partnerships, corporations), including any non-arm s length farming relationship and any relationship involving business transactions that fall below or exceed what would be considered fair market value or barter. I acknowledge that I am required to provide Agricorp with all information and records relevant to the farming operations of any other participant(s) named in my AgriStability forms or the farming operations of any individuals, partners and shareholders who may be involved or related to my farming operations, in order to be considered for AgriStability payments. 11. I understand that any information submitted may be evaluated with the information of other participants for the purpose of determining whether our farming operations should be combined when determining entitlement to AgriStability payments and that this information that I submitted may be disclosed to these other participants Year-end Report and Claim Form AgriStability Page 6 of 7

7 12. I consent to Agricorp s access to the Canada Revenue Agency, Production Insurance and Risk Management Program information, and information from other past and present federal and/or provincial programs related to my farming activities. This information may be used to determine my reference margin and program year production margin and specifically to verify the information provided in my AgriStability forms or supporting documents, or during any audit. Fees, overpayments and recoveries 13. I will pay all applicable fees and charges to participate in the AgriStability program. 14. I confirm that any payments that I received under the AgriStability program beyond the amount I am entitled to in the program year, or in contravention of (i) any program requirements, (ii) the obligations set out in this form, or (iii) the laws of Ontario or Canada, will be considered an overpayment and a debt due and payable to the Crown in right of Ontario or Canada. I confirm that these overpayments will be repaid either by offset from payments owing to me under this or any other program administered or delivered by Agricorp, or under federal and/or provincial income tax and other federal and/or provincial programs, or by payment to Agricorp upon demand, including any interest on such overpayments at the rate set quarterly by the Ontario Ministry of Finance. This obligation is not subject to a limitation period and will survive any cancellation or termination of my participation in the AgriStability program. 15. Any funds payable to me under this program may be subject to recovery or offset against any pre-existing debts I may have to the Crown in right of Ontario or Canada. Using and sharing information 16. I agree that the information collected on the AgriStability forms and in supporting documents may be used and disclosed for the purposes of administering, auditing and evaluating the following programs, including my participation in these programs: (a) the AgriStability program under the Federal/Provincial/Territorial Growing Forward 2 Agreement, as amended, or any subsequent federal/provincial agreement, (b) other programs administered by Agricorp, including, without limitation, the Farm Business Registration program, and (c) other farm income and special assistance programs. In addition, information may be shared with the Ontario Ministry of Agriculture, Food and Rural Affairs, Agriculture and Agri-Food Canada and other provincial or federal ministries or agencies for the purpose of developing other agricultural policies and programs. 17. Information collected in this form may be used by Agricorp or shared with provincial or federal ministries or agencies for the purpose of recovering overpayments. 18. For the purpose of emergency management, I also consent to the use by provincial, federal, or municipal government authorities of agricultural production and contact information collected in this form and other AgriStability documents. Emergency management includes planning, activities and programs for preventing, preparing for, responding to, and recovering from emergencies. If I am signing this document on behalf of a corporate entity, I certify that I am an officer of that corporate entity with lawful authority to sign on behalf of and to bind that corporate entity. Name (please print) Signature X Date YYYY/MM/DD I would like to receive a Towards Increased Profits (TIP) report, which is a financial analysis of my farm business based on the information submitted. Section G: Submit completed form Mail or fax Agricorp 1 Stone Rd. W. Box 3660 Stn. Central Guelph, ON N1H 8M4 Fax: Questions? Mon. to Fri., 7 to 5 agricorp.com contact@agricorp.com TTY: Notice: Agricorp reserves the right to correct any errors or omissions on this document. Agricorp collects social insurance numbers for the purpose of making payments under this program and for the purposes of tax, auditing and collection of overpayments. This information will be shared with the Canada Revenue Agency for the purpose of issuing tax receipts for payments. Questions about the collection of this information can be directed to Agricorp s Compliance and FOI-Privacy Specialist, Box 3660, Stn. Central, Guelph, ON N1H 8M4, Year-end Report and Claim Form AgriStability Page 7 of 7