Agent/Agency Registration Form
| Published date | 01 September 2020 |
Online Services, Accounts Division: Version 05/2023
I acknowledge that the data to which I will have access is confidential and is covered by current Data Protection legislation and Regulation (EU) No
2016/679 (General Data Protection Regulation) effective from 25 May 2018. I understand that this information is made available to me for the purposes
of submitting application forms online on behalf of my clients for the Schemes indicated above. I undertake to use the information solely for the
purposes for which it is intended and not to disclose it to third parties. I confirm that I will keep my log-on details confidential and will not disclose them
to a third party. I agree to indemnify the Minister for Agriculture, Food and the Marine from any losses, damages, liabilities, costs and expenses
(including necessary legal expenses) arising out of injury, loss or damage to any person whatsoever, resulting from or in any way connected with or
arising out of the use of the Department’s Single Sign On System or the use of any data provided by the Department by whatsoever means by myself,
my servants or agents. I confirm that the information on this form is correct to the best of my knowledge and that it refers to me. I hereby declare that I
am aware of the attached Terms and Conditions pertaining to this application and agree to comply fully with these requirements.
I
wi
s
h
t
o
appl
y t
o
t
he
Depar
t
men
t
o
f A
gri
c
ul
t
ure
, F
ood
& t
he
Marine
✓t
o
be
regi
st
ered
a
s
an
A
gri
c
ul
t
ure
A
gen
t
✓t
o
be
regi
st
ered
f
or
a
cc
e
ss t
o
t
he
Depar
t
men
t
’
s S
ingle
S
ign
O
n
syst
em
✓t
o
be
gran
t
ed
t
he
au
t
hori
ty t
o
s
ubmi
t
appli
c
a
t
ion
f
orm
s
online
on
behal
f
o
f
m
y c
lien
ts f
or s chemes listed below
✓t
o
be
gran
t
ed
t
he
au
t
hori
ty t
o
s
ubmi
t
appli
c
a
t
ion
f
orm
s
online
for
any future applic able s chemes introd uced
*Area Based & Livestock Schemes
BPS/Greening/ANC/Entitlement Related Applications
Targeted Agricultural Modernisation (TAMS) schemes
O
rgani
c F
arming
Sc
heme
Agri Climate Rural Environmental Scheme
(ACRES)
Form DAFMReg 1 - Page 1 of 4
Form DAFMReg 1
Application to register as an Agriculture Agent
Panel
A
-
Agent
details.
To b
e
c
o
m
pl
ete
d b
y
t
h
e
a
g
e
n
t
.
A
ll
f
i
e
ld
s
are
ma
nd
at
o
ry
Pl
ease
u
se
B
lo
ck
Ca
pi
ta
l
s
.
Are you Farm Advisory System (FAS) approved?
Yes
No
Title:
________
First
Name:
________________________
Surname:
______________________________
Address:
___________________________________________________________________________
__
___________________________________________________________________
Signed ______________________________________________ Date: _____________________
Please return this form by email to
agfood@agriculture.gov.ie or to
On-Line Services Section,
Department of Agriculture, Food & the Marine
Government Buildings,
Farnham Street, Cavan.
H12 D459
If
you
have
any
queries
in
relation
to
the
form,
please
contact
this
unit
at
(
049) 436 8288
Gender:
Male Female
Date
of
Birth:
__/___/___
Mobile
N
o:
_________________
If
mobile
given,
do
you
wish
to
receive
SMS
messages
?
Yes
No
Email
Address:
___________________________________________________
Your
Agriculture
Agent
number
will
be
issued
to
this
email
address
* Area Based & Livestock schemes comprise the following and their successors under future CAP: Basic Income Support for Sustainability (BISS)/Entitlements/Complementary
Redistributive Income Support for Sustainability (CRISS)/ Complimentary Income Support for Young Farmers (CISYV) /Eco-scheme/Protein Aid/ANC/Straw Incorporation
Measure(SIM), Beef Environmental Efficiency Programme (BEEP), S uckler Carbon Efficiency Programme, new Exceptional Aid Measures, Sheep Improvement Scheme,
Knowledge Transfer Programme, Dairy Beef Welfare Scheme, National Fertiliser Database and any future schemes that are not covered under the authorisations above.
Have
you
any
other
registration
with
the
Department
of
Agriculture,
Food
&
the
Marine?
Yes
No
e.g.
Agricultural
Agent,
Herd
Owner.
Please
quote
reference
number(s)
AGT etc______________________
Personal
Details
Personal
Public
Services
Number
(PPS
No)
Format
of
PPS
No
is
7
numbers
followed
by
1
or
2
letters
as
printed
on
any
corresponden ce
from
the
Revenue
Commissioners
or
Departm ent
of
Social
Protection.
Multi Species Swards Measure
Existing Exceptional Aid Schemes
Nitrates & Phosphorous Statements
Ag Schemes Nitrate Derogation
Soil Sampling
Agency
details
Name
of
agency
that
you
are
employed
by or subcontracted to
_______________________________________
Please
ask
the
manager o f the agency
to
complete
the
form
overleaf.
Applicant’s
Declaration
Are you a sub-contractor?
Yes
No
If Yes, please quote Agency No. that you are subcontracted to AGY_____________
Farm Advisory System (FAS) Approved
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