Application for Certificate of Registration – Jamaica Agricultural Commodities Regulatory Authority

Government of Jamaica

FORM 4 (Regulation (8(1))

Basic Information

Full Name

Date of Birth

Age

Date of Incorporation/Registration of Company/Business

Address of Applicant

Mailing Address (if different from above)

Telephone

Fax

Website URL

Identification

Form of government issued ID: Voters IDDriver's LicensePassportOther

ID Type:

ID Number:

Tax Registration Number (TRN)

Property Information

Name of owner of property on which a regulated agricultural commodity is grown, if different from applicant:

Address of property on which a regulated agricultural commodity is grown, if different from above:

Is this property leasehold? NoYes

Date of Lease

Period of Lease

Acreage of property:

Acreage of property under a regulated agricultural commodity:

Estimated number of a regulated agricultural commodity grown on property:

Estimated amount of regulated agricultural commodity produced in crop year immediately preceding the year in which the application is being made:

Statement by Applicant I accept the Terms in the Statement below.

I/We hereby certify that the information contained in this application and any document submitted to the Authority, are true and completed to the best of my/our knowledge and belief.

I/We understand that any misrepresentation contained in the form shall lead to discontinuation of the processing of the application and the revocation of any licence granted and may also lead to prosecution. I/We further understand that the licence, if granted, may be suspended or revoked for breach of any of the terms or conditions stipulated therein.