Farmland Allocation Lease Subscription Form Kindly fill the form with correct details and well spelt names as any corrections on issued documents occur by any mistake in filling this form will attract correction fees Page 1 of 7Selection of Plot Size and Agricultural TypeFruits & Vegetables Crops Estate Layout*None1 Acre (5 Plots) – N200,000.00 per annum1 Hectare (10 Plots) – N400,000.00 per annumFood & Staples Crops Estate Layout*1 Acre (5 Plots) – N200,000.00 per annum1 Hectare (10 Plots) – N400,000.00 per annum2 Hectares (20 Plots) – N800,000.00 per annum3 Hectares (30 Plots) – N1,200,000.00 per annum4 Hectares (40 Plots) – N1,600,000.00 per annum5 Hectares (50 Plots) – N2,000,000.00 per annumNote: The annual rental fee includes essential services such as farm security, estate insurance, land clearing, and irrigation. Additional services are available for an extra charge.NextSubscriber DetailsUpload Passport Photograph*Name*FirstLastDate of Birth*GenderPlease selectMaleFemaleOccupation *Organization Name*Email address*Road/Street/Post OfficeTown/CIty/DistrictMarital Status*Please selectSingleMarriedDivorcedWidowedNationalityPlease selectAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua And BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia And HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo, The Democratic Republic Of TheCook IslandsCosta RicaCote D'IvoireCroatia (Local Name: Hrvatska)CubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard And Mc Donald IslandsHoly See (Vatican City State)HondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic Of)IraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic OfKorea, Republic OfKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacauMacedonia, Former Yugoslav Republic OfMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia, Federated States OfMoldova, Republic OfMonacoMongoliaMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint Kitts And NevisSaint LuciaSaint Vincent And The GrenadinesSamoaSan MarinoSao Tome And PrincipeSaudi ArabiaSenegalSeychellesSierra LeoneSingaporeSlovakia (Slovak Republic)SloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia, South Sandwich IslandsSpainSri LankaSt. HelenaSt. Pierre And MiquelonSudanSurinameSvalbard And Jan Mayen IslandsSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzania, United Republic OfThailandTogoTokelauTongaTrinidad And TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis And Futuna IslandsWestern SaharaYemenYugoslaviaZambiaZimbabwePhone Number*NIN Number*Whatsapp Number*BackNextIdentity Proof of Next of KinName of Next of Kin*FirstLastRelationship with Next of KIn*Please selectSpouseson, daughter Parent – FatherParent – Mother Siblings – BrotherSiblings – Sister Family – Aunty Family – Uncle Family – Niece Family – Nephew GrandchildAddress of Next of KinEmail address*Phone Number*BackNextFarming HistoryDo You Have Any Experience In Farming?*Please selectYesNoAre you a registered Farmer?*Please selectYesNoIf Yes, Please Explain The Type And Years Of Experience:*What Type Of Crop Will You Be Cultivating?*Amount Of Land Size Requested For Farming?*How Soon Will You Be Able To Begin The Cultivation, If Your Application Is Successful?*What Method Of Funding Will You Be Using?*Private/Personal FundingPrivate (Partnership) Bank LoanAre you interested in the Farm Financing Scheme from the Quebec AgrifoodPro Cooperative, funded by the Bank of Agriculture (BOA)? 35% equity contribution is required, along with membership in the cooperative and cluster group.BackNextPlot Managers DetailsName*FirstLastAddress*Phone Number*Email*NIN Number*Whatsapp Number*BackNextDeclaration and UndertakingI,Full name, the undersigned, residing at the address provided above and contactable at the stated phone number, hereby confirm that I have thoroughly reviewed and comprehended the information contained in the promotional materials disseminated by the Farm Estate Developer regarding the Quebec Agritech City – Farm Estate project situated at Angwan Zeiko through Baduku Junction, Kokona Local Government Area in Nasarawa State. The materials encompass details such as the project layout, crop varieties available for cultivation, and the terms and conditions governing the allocation of farmland plots. I avow to adhere to all stipulations set forth in the aforementioned materials and to actively support the progression of the project. Furthermore, I affirm the acceptability of the terms and conditions and acknowledge the receipt of copies of the marketing materials. I acknowledge the prerogative of the developer to reassign plots should the subscriber neglect to remit payment within the prescribed two-week period subsequent to the site inspection, as a measure to uphold the project’s development schedule. I attest to the accuracy of the provided information and acknowledge that any discrepancies therein will be my sole responsibility. Additionally, I pledge to uphold all provisions to facilitate the realization of the Future City project.BackNextPayment Instructions: All documentation regarding evidence of payments should be submitted via email to [email protected], with a copy sent to [email protected]. 1. Reservation of Interest (N10,000.00): Bank: Nirsal Microfinance Bank Ltd Account Name: Quebec Agricultural & Food Processing Cooperative Society Ltd Account Number: 0251625871 2. Annual Rental Payment: Bank: Sterling Bank Plc Account Name: Quebec AgrifoodPro Coop Account Number: 0083936877 Please direct all payments to the specified accounts. Thank you. Please Upload proof of N10,000 – Reservation of Interest *BackSendThis field should be left blank