SOP Exhibits
Title:NFA Lingap Para Sa Mahihirap Farmers Alleviation Program
Application Form

SOP Number : TS-ES14

D
NFA LINGAP PARA SA MAHIHIRAP
FARMERS ALLEVIATION PROGRAM
LOCALL FOOD SECURITY PROJECT
APPLICATION FORM

Region/Province : _______________________
Application No. : _______________________
Date Received : _______________________

I. PERSONAL DATA

Name of Farmer-Borrower : _____________________________________ age : ________
Home Address : ____________________________________________________________
Marital Status : ______________Name of Spouse : ________________________________
No. of Dependents : _________________________________________________________

Farming Status : a. ( ) Owner Tiller b. ( ) Tenant Tiller c. ( ) Lease Holder
(Attach Xerox copy of land title or Certification from DA or DAR in case of b & c)

No. of years in Farming : ______ Farm Location : _________________________________
(Draw sketch location at the back of this form)

Farm Size : _______ (ha) No. of Hectares Applied : ____________

Farmers Affiliation to Various Farmers Organizations/Cooperatives :
_________________________________________________________________________
_________________________________________________________________________

Training/s Attended : Conducted by :

__________________________________ ______________________________
__________________________________ ______________________________

Sources of Income Aside from Farming : Amount of Income (per day/month)
__________________________________ ______________________________
__________________________________ ______________________________

II. PRODUCTION DATA

Production Facilities Owned : Number of Units : Post Prod'n Facilities Owned : Number of Units
______________________ _____________ _______________________ ____________
______________________ _____________ _______________________ ____________

Number of Cropping/s ( ) One ( ) Two ( ) Three ( ) Others ______

Preferred Rice Variety to be Planted : ________ Rice Variety Previously Planted : __________

Previous Average Yield : ________ (cav./ha.) Source/s of Seeds : ____________________

No. of Kilos Used as Seed/ha. : ______ Estimated Cost of Production/ha. : P ____________

Source/s of Inputs : __________________________________________________________

Sources of Capital : ( ) Family Savings/Earnings ( ) Bank : _________ ( ) Private Financier

Rate of Interest : ____________ Mode of Payment of Loans : ( ) Cash ( ) Payment-in-Kind

Sources of Irrigation Water : ( ) NIA ( ) SFR ( ) SWIP ( ) Others ____________________

Cost of Irrigation/hectare/cropping P ___________

III. POST-PRODUCTION AND MARKETING DATA

To whom are you selling your produce : Selling Price Reason for your Choice
per Kilogram of Market Outlet

NFA __________ __________________
Financiers __________ __________________
Cooperative __________ __________________
Others (specify) __________ __________________

Are you aware or have availed of any of the following NFA Program :

Aware Availed Did not Avail Not Aware

Institutionalized Procurement Program _____ ______ __________ _________
Price Support Program _____ ______ __________ _________
Grains Inventory Financing Technique _____ ______ __________ _________
Farmers Grains Exchange Program _____ ______ __________ _________
__________
Farmers Incentive Rice Purhase Program _____ ______ __________ _________
NFA-JICA Post-Harvest Facility Asst. Prog. _____ ______ __________ _________
Farmers Training (PHT/ENTREP) _____ ______ __________ _________
e-STRADA _____ ______ __________ _________
Cooperative Dev't Incentive Fund (CDIF) _____ ______ __________ _________
Farm Level Grains Center _____ ______ __________ _________
Municipal Level Grains Center ______ ______ __________ _________
Others : _____ ______ __________ _________

============================================================================
I hereby certify that Mr./Ms. _______________________________ is a bonafide marginal farmer, residing at _______________________________________________________________________
______________________________________________________________________________

______________________________
Name and Signature of
Barangay Chairman


______________________________
Date

LOCAL FOOD SECURITY PROJECT
Evaluation of Application

CERTIFICATION

This is to certify that Mr./Ms. __________________________ is the true ( ) Owner Tiller ( ) Leasehodler of the farm lot with an area of ______ located in barangay ______________________, municipality of ________________________ province of _______________________.


_________________________________
Name and Signature of NFA Provincial
Investigator/Date

C E R T I F I C A T I O N

This is to certify further that the ____________________ (has.) farm as shown in the Sketch Plan of the above-named farmer borrower has been inspected and has been found to be agro climatically and topographically suitable to rice production. Said farmer-borrower is qualified to avail of production loan specified below amount to P _________________________.

COMPONENTS QUANTITY AMOUNT (P)

1. Certified/Registered Seeds _________________ ________________
2. Commercial Organic Fertilizer _________________ ________________
3. Complete Fertilizer (14-14-14) _________________ ________________
4. Ammonium Phosphate (16-20-0) _________________ ________________
5. Urea or Ammosol (45-0-0/21-0-0) _________________ ________________
6. Zinc Sulfate (Zn S04) _________________ ________________
7. Insecticides _________________ ________________
8. Rodenticides _________________ ________________
9. Weedicides _________________ ________________
10. Irrigation Fee _________________ ________________
11. Crop Insurance Premium _________________ ________________

TOTAL _________________ ________________

Recommending Approval:

________________________________
Name & Signature of NFA PMDO/Date

I hereby certify the validity of all the statement stated herein and have found in order for
its approval.

Approved/Confirned

____________________________
NFA Provincial Manager