South Sudan Ministry of Agriculture

SOUTH SUDAN MINISTRY OF AGRICULTURE MANAGEMENT SYSTEM

SUBSIDIY OF SMALL FARMERS

Download Form

Agent Code

Farmer Registration Code

Personal Infomation

National ID No

Proposal Serial No

Name Of the farmer

Father Name/Husband Name

Address

Primary Mobile No

Alternate Mobile No

Nominee

Nominee Relationship

Bank Details

Bank A/C No

Bank Name

Account Type

Agent Details

Agent Name

Agent Code

Phone No

Land Information

State/Area

City

Counti

Ledger Folio Number:

Survey No:

Season

Crop

Area Sown(Ha):

Date of Sowing:

Date/Place

Signature of Farmer -------------------

Receipt & Acknowledgement

Insurer NIC:

Proposal Serial No:

Crop

Season

Area Insured(Ha):

Rev Village:

Date/Place

Agent Representative Signature & Address Seal -------------------