Claim Form - Rural Development Programme 2014-2020
ID Card No
Building Entry Point Name
Claim Form European Agricultural Fund for Rural Development (EAFRD) MeasuresAgriculture & Rural Payments AgencyNon-Integrated Administration and Control System (IACS) Schemes
Name of beneficiary
Surname of beneficiary
Project reference number
Grant Agreement (GA) details
Date of grant agreement
Cheque/Bank transfer number
Serial number (for machinery/equipment only)
Name of supplier
Cost excluding. VAT (Euro)
Total including VAT (Euro)
Grant rate %
Eligible cost (Euro)
Cost excluding. VAT ( Euro)
Cost excluding. VAT (in Euro)
Claim details total
The information collected in this form is being collected in order to process claims related to pre-approved funding. Any information collected shall be processed in accordance with the Data Protection Act, Cap 440 of the Laws of Malta.
I hereby authorise the Paying Agency to process the data contained in this form for the purpose stated above.
Name and surname of person compiling and submitting this claim
I declare that the attached invoices are in line with the conditions stipulated in the GA and that information provided is true and correct.
For Paying Agency use only
All specifications in invoices submitted are eligible for payment
All payments are covered by proof of payment, including VAT receipt, cheque image/brank transfer
Payment claim does not exceed 10% sanction threshold as per EC Regulation 809/2014, Article 63
Data Protection Policy
The Agriculture and Rural Payments Agency carries out its functions in accordance with the applicable law and in line with standing good practices. In line with Article 13 of Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 on the protection of natural persons with regard to the processing of personal data and on the free movement of such data, and repealing Directive 95/46/EC (hereafter ‘ The General Data Protection Regulation’ or ‘The Regulation’), the Agency is hereby providing you with the following information: •The “Controller” is the Agriculture and Rural Payments Agency and it can be contacted at the Government Farm, Għammieri, Marsa, Malta or on the email address email@example.com;•The “Data Protection Officer” can be contacted at the Agriculture and Rural Payments Agency, Government Farm, Għammieri, Marsa, Malta or on the email address firstname.lastname@example.org;•The purpose of processing your personal data is to implement the measures under the Common Agricultural Policy in accordance with Title III of the Treaty on the Functioning of the European Union and related EU and National Law;•The recipient of your personal data is the Agriculture and Rural Payments Agency within the Ministry for the Environment, Sustainable Development and Climate Change. The category of recipients of your personal data is public authorities including also Union institutions, bodies, offices and agencies; •Your personal data shall be stored for the maximum period required or allowable under law, including in particular the applicable EU law implementing the Common Agricultural Policy;•You have the right to request from the Controller access to and rectification or erasure of personal data or restriction of processing of personal data concerning yourself or to object to processing as well as the right to data portability, in accordance to law; •You have the right to lodge a complaint with the Office of the Information and Data Protection Commissioner, or any other supervisory authority, if applicable in accordance with the Regulation; The personal data you are providing to us is a contractual requirement. By submitting this application form you are declaring that you understand and accept that such submission constitutes a clear affirmative declaration of your specific, informed and unambiguous consent being given by you to the Agency for the Agency to process personal data relating to you for the specific purpose of processing this application form, in accordance to law. In order for your Application Form to be processed, you are obliged to provide your personal data. Failure to provide such data will result in the impossibility of processing your application form.