Business mailing address (include civic number and road name) City/Town Province Postal code

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1 2013 Application RMP for livestock Cattle Hogs Sheep Veal This application is for: Producers applying to RMP for livestock for the first time, or Current RMP for livestock participants enrolling in a new livestock plan. Please read the 2013 Handbook RMP for livestock before completing this application. The handbook outlines important details about information you are asked to provide. You can apply to the Risk Management Program (RMP) as a sole proprietor, corporation, limited partnership or partnership. Only one application is required per partnership. If you are applying as a trust, cooperative or estate, please contact Agricorp for instructions on how to complete this form. An application is required for each business where all aspects of the farm operations (i.e., accounting, bank accounts, income tax filing, and production) are completely separate. An electronic version of this form is available on agricorp.com. Section A: Customer information Select one Sole proprietor Corporation Limited partnership Partnership Agricorp ID (for current participants) Livestock policy number (for current participants) A Business name (for sole proprietor, include first, middle and last name) Business mailing address (include civic number and road name) Business address (optional) City/Town Province Postal code Primary business telephone number Alternate business telephone number Business fax number (optional) Section B: Main farm location County/District/Region Municipality Geographical township Lot Concession Premises identification number O N Section C: For sole proprietors only (as named in Section A) Social insurance number (SIN) AgriStability PIN (if you do not currently participate in AgriStability, you must apply by April 30) Application RMP for livestock Page 1 of 8

2 Section D: For corporations only (as named in Section A) Business number (BN) AgriStability PIN (if you do not currently participate in AgriStability, you must apply by April 30) Provide details of shareholder s interest in any other farm business participating in an Agricorp program. Business name Business Production Insurance customer number Business AgriStability PIN Attach additional pages as required. Section E: For limited partnerships and partnerships only (as named in Section A) Business number (BN) Partner name and address (individual or corporation) Ownership (must total 100) Social insurance number (SIN) for individuals Business number (BN) for corporations AgriStability PIN (if you do not currently participate in AgriStability, you must apply by April 30) Attach additional pages as required Application RMP for livestock Page 2 of 8

3 Section F: Your farming information In order to help Agricorp process your application, please answer the questions below. 1. What types of livestock do you produce? Cattle Hogs Sheep Veal 2. Do you own or raise any livestock outside of Ontario in the same categories you re selecting for enrolment? Yes No 3. Do you custom-feed any livestock in the same categories you re selecting for enrolment? Yes No 4. Are you involved in any share or lease arrangements for the livestock you re enrolling? Yes No 5. Are you involved in any joint venture or joint ownership of the livestock you re enrolling? Yes No Section G: Coverage selection Select all the plans and categories you want to enrol in as well as your coverage level for each category. For full coverage, enrol in all categories in which you have eligible production. For each category in which you enrol, you must complete the corresponding information sections that follow. Premium rates vary by coverage level and are listed in the livestock handbook. Livestock plan Category Coverage level RMP: Cattle (complete Cattle information) RMP: Hogs (complete Hogs information) RMP: Sheep (complete Sheep information) Cow-calf (steers up to 550 lb.; heifers up to 500 lb.) Backgrounder (steers lb.; heifers: lb.) Feedlot (steers lb.; heifers: lb.)* Early wean (7 kg) Feeder (25 kg - includes off-type animals such as breeding stock and barbecue pigs)* Grower/finisher ( kg includes slaughter sales only)* Lambs ( lb.) RMP: Veal Grain-fed ( lb.) (complete Veal information) Milk-fed ( lb.) * Animals sold above the maximum weight can be enrolled, but any weight gain exceeding the maximum will not be eligible for payment Application RMP for livestock Page 3 of 8

4 Cattle information Please read the RMP: Cattle section of the 2013 handbook for eligibility criteria and reporting requirements. Description of operation Type(s) of operation - select all that apply Cow-calf Cow-calf to backgrounder Cow-calf to feedlot Purchase calves for backgrounding Purchase calves for backgrounding and feedlot Feedlot Estimated average number of beef cows in breeding herd for 2013 (if applicable) Projected cattle sales for 2013 Record your projected cattle sales for 2013 in the chart below. Your projected sales determine your insured production for the categories you ve selected as well as your premium. Record only eligible cattle you plan to sell in the 2013 calendar year. If you enrolled in multiple categories, production of cattle that span multiple categories will be calculated by Agricorp. During the course of the year, if you expect your annual projected sales to change by more than 25 you are required to notify Agricorp. Projected cattle sales Breakdown of projected cattle sales No. of head Average live sale weight (lb.) Raised from birth Purchased as calves Purchased as backgrounders No. of head No. of head Average purchase weight (lb.) No. of head Average purchase weight (lb.) Projected calf sales (raised from birth)* Heifers Steers Projected backgrounder sales* Heifers Steers Projected feedlot sales* Heifers Steers * You must own and produce the cattle in Ontario for at least 120 days. This ownership and production can span multiple categories Application RMP for livestock Page 4 of 8

5 Hog information Please read the RMP: Hogs section of the 2013 handbook for eligibility criteria and reporting requirements. Description of operation Type(s) of operation - select all that apply Farrow to early wean Farrow to feeder Farrow to finish Early wean to feeder Early wean to finish Feeder to finish Estimated average number of sows in breeding herd for 2013 (if applicable) Projected hog sales for 2013 Record your projected hog sales for 2013 in the chart below. Your projected sales determine your insured production for the categories you ve selected as well as your premium. Record only eligible hogs you plan to sell in the 2013 calendar year. If you enrolled in multiple categories, production of hogs that span multiple categories will be calculated by Agricorp. During the course of the year, if you expect your annual projected sales to change by more than 25 you are required to notify Agricorp. Projected hog sales Breakdown of projected hog sales No. of head Average live sale weight (kg) No. raised from birth No. purchased as early wean No. purchased as feeder Projected early wean sales* Early wean *You must own and produce the hogs in Ontario for at least 15 days. Projected feeder sales* Feeder *You must own and produce the hogs in Ontario for at least 35 days. Include off-type animal sold above 25 kg, such as breeding stock and barbecue pigs. Projected grower/finisher sales* Grower/finisher *You must own and produce the hogs in Ontario for at least 70 days. Include sales of slaughter animals above 87.5 kg only Application RMP for livestock Page 5 of 8

6 Sheep information Please read the RMP: Sheep section of the 2013 handbook for eligibility criteria and reporting requirements. Description of operation Estimated average number of ewes in breeding flock for 2013 (if applicable) Do you purchase lambs for further finishing? Yes No Projected lamb sales for 2013 Record your projected lamb sales for 2013 in the chart below. Your projected sales determine your insured production and your premium. Record only eligible lambs you plan to sell in the 2013 calendar year. During the course of the year, if you expect your annual projected sales to change by more than 25 you are required to notify Agricorp. Projected lamb sales No. of head Average live sale weight (lb.) No. raised from birth No. purchased as feeder lambs Average purchase weight (lb.) Lambs* *You must own and produce the lambs in Ontario for at least 30 days Application RMP for livestock Page 6 of 8

7 Veal information Please read the RMP: Veal section of the 2013 handbook for eligibility criteria and reporting requirements. Projected veal sales for 2013 Record your projected veal calf sales for 2013 in the chart below. Your projected sales determine your insured production and your premium. Record only eligible veal calves you plan to sell in the 2013 calendar year. During the course of the year, if you expect your annual projected sales to change by more than 25 you are required to notify Agricorp. Projected veal calf sales* No. of head Grain-fed ( lb. live) Milk-fed ( lb. live) *You must own and produce the veal calves in Ontario for at least 90 days. Section H: Premium payment schedule Choose your preferred premium payment schedule. If no payment schedule is chosen, you will be invoiced semi-annually. If your annual premium is less than $200, you will automatically be invoiced annually. One annual payment Two semi-annual payments 2013 Application RMP for livestock Page 7 of 8

8 Section I: Agreement and signature I understand and agree to: Abide by all terms, conditions and procedures of the program as set out in the 2013 Handbook RMP for livestock. Provide accurate, timely and full information to Agricorp and notify Agricorp in the event that there are any changes to information I have provided. I certify that: All information submitted on this application is accurate and true. None of the livestock listed on this form are enrolled in the name of another business or individual in the same livestock plan and category of the 2013 Risk Management Program. I am enrolling all of my eligible livestock for which I ve selected coverage, and have not enrolled any of that livestock more than once. I have met the minimum ownership and maximum livestock age requirements below and all livestock included on this application have been raised in Ontario by me for the required time periods. Plan Minimum ownership in Ontario Maximum livestock age Cattle 120 days 30 months Hogs Early wean 15 days n/a Feeder 35 days Grower/finisher 70 days Sheep 30 days 1 year Veal 90 days n/a I consent to: On-site audits by Agricorp personnel at any time to verify program eligibility and to evaluate compliance with the requirements of this program. Reviews performed by Agricorp, as necessary, of all information related to other programs delivered by Agricorp in which I am enrolled. I acknowledge that: If it is determined that I have received funds as an overpayment, or in contravention of the program requirements, the obligations set out in this application, and/or the laws of Ontario and Canada, I must return all or part of the funds received, as determined by Agricorp. Any funds payable to me under this program may be subject to recovery or offset against my pre-existing debts to the Crown in right of Ontario and Canada. By signing below, I certify that all information submitted on this form is accurate and true. Signature of (select one) Sole proprietor Signing officer(s) Partner(s) Other signing authority (e.g., executor, power of attorney) Print name Signature X Date Print name Signature X If submitting a printed form, all partners must sign. YYYY/MM/DD Date YYYY/MM/DD Section J: Submit completed form Submit online To submit this form online, click Submit once. You will receive a confirmation number within a few minutes. Mail or fax Agricorp 1 Stone Road West Box 3660 Stn. Central Guelph, ON N1H 8M4 Fax: Questions? Mon. to Fri., 7 to 5 agricorp.com contact@agricorp.com TTY: Notice: For specific legal obligations under the program, please refer to the 2013 Handbook RMP for livestock (enclosed and also available on agricorp.com), the RMP: Cattle 2013 Guidelines, RMP: Sheep 2013 Guidelines, RMP: Hogs 2013 Guidelines, RMP: Veal 2013 Guidelines and orders in council 1309/2011 and 1310/2011, as amended (available through Information collected is used by Agricorp to administer RMP for livestock. This information may be used and disclosed for the purpose of administering, auditing and evaluating the program, as well as other programs administered by Agricorp. This includes sharing information with the Ontario Ministry of Agriculture and Food. 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 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 FOI-Privacy Advisor, Box 3660, Stn. Central, Guelph, ON N1H 8M4, Errors and omissions excepted Version française disponible 2013 Application RMP for livestock Page 8 of 8