Supplier Application Form Milk
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Entered:
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Hokitika Head Office 56 Livingstone Street PO Box 96 Hokitika 7842 New Zealand Telephone +64 3 756 9800 Facsimile +64 3 755 8208 Christchurch Branch 41 Westland Place PO Box 138 Rolleston 7677 Christchurch New Zealand Telephone +64 3 371 1600 Facsimile +64 3 347 4652 Email
[email protected] www.westland.co.nz Page 1 of 6
Supplier Application Form Milk Use this application form if you wish to apply to supply milk to Westland Milk Products. Important Note This application form is for milk supplied in accordance with Westland Milk Products Milk Collection Season Policy (refer schedule 7 of the Suppliers Handbook) and excludes winter milk, colostrum and other specialty milk such as organic milk.
To complete this application form you will need • • • • • • •
Applicant name and details Contact details Bank account details GST number Farm area and effective area to be used for dairying Contactable on farm worker details Commencement Date (This will be the date you take possession of the farm or, for a new conversion, the date you intend to start supplying milk.) • Veterinary Details
Additional information which may be required: • Forecast number of cows and production for the next five years • A copy of the certificate of title • Sharemilker/Contract Milker details
Any queries If you need assistance to complete this form you can call the Supplier Payments Officer on (03) 756 9852. Application approval process Applications must be received by the Supplier Payments Officer at least 20 days prior to the next Board meeting for processing. We will advise you whether or not your application has been accepted following the Board meeting. Please contact the Supplier Payments Officer should you not receive this letter within one month. Terms and Conditions of Supply If your application is accepted you will be legally bound to supply milk to Westland Milk Products in accord with the Constitution and Terms and Conditions of Supply (available on request by phoning 0800 732 700). Shareholding Requirements For information on Westland Milk Products shares refer to the Investment Statement on www.westland.co.nz Share Transfers If you are purchasing shares from an existing supplying shareholder a correctly completed share transfer must be received at least 20 days prior to the Board meeting in the first month of milk supply. Sharemilkers/Contract Milkers A Notification of New Sharemilker/Contract Milker form (available on request by phoning 0800 732 700) must be received by the Supplier Payments Officer in the month preceeding commencement of their contract.
Please return completed application form to: SUPPLIER PAYMENTS OFFICER WESTLAND MILK PRODUCTS PO BOX 96 HOKITIKA 7842 Forms may be faxed or scanned (in pdf format and emailed to
[email protected]) but the originals are required via post at your earliest convenience.
Page 2 of 6 Form ID: FIM F10/1
Supplier Application Form Milk Office use only Farm Number (Office use only)
1. Applicant Details Full Name(s) of Applicant (this is the name under which you will supply Westland Milk Products)
Type of Applicant (please tick one)
Sole Trader
Partnership
Limited Partnership
Company
Trust
Estate
Details of Applicant For a Sole Trader state full name. For Partnerships, state full names of all partners. For a Limited Partnership, state the full name of the General Partner(s). For Companies, state the full registered company name and company number. For Trusts, state the full names of all trustees. For Estates, state the full names of all executors.
Contact Details of Applicant Contact Person
Postal Address (include farm name if applicable) Phone
Fax
Cell Phone
E-mail
Post Code
Bank Account Details
Bank
Branch
Account Number
Suffix
GST Number
Page 3 of 6 Form ID: FIM F10/1
Supplier Application Form Milk 2. Farm Details Commencement Date
Day
Month
Year
Area of Farm
Effective Area (to be used for dairying)
Physical address of Farm
Farm Type (please tick one)
Farm is currently supplying Westland Milk Products Farm is a new conversion
Farm is currently supplying another dairy company List the supply number
Company Name
Have you moved from another Westland Milk Products supplying farm? (please tick one) Y
N
If yes list the supply number
Will you be supplying Westland Milk Products from any other farms already supplying Westland Milk Products? (please tick one) Y
N
If yes list the supply number
Is the Farm to be amalgamated with another farm supplying Westland Milk Products? (please tick one) Y
N
If yes list the supply number
Contactable On-Farm Worker/Manager For Laboratory and Milk Collection use (if different from Contact Person above) Full Name Phone
Fax
Cell Phone
E-mail
Vet responsible for Leptospirosis vaccinations for herd Full Name Address of Vet
Page 4 of 6 Form ID: FIM F10/1
Supplier Application Form Milk Additional information for new conversions only Forecast of cow numbers and production Year
Cows
KG milk solids (milk fat + protein)
First Second Third Fourth Fifth
Colostrum Supply Are you interested in supplying colostrum (please tick one) Y
N
Important Note Westland Milk Products will accept the supply of colostrum at its absolute discretion.
Sharemilker/Contract Milker Details Will there be a Sharemilker/Contract Milker on this Farm for the coming season? (please tick one) Y
N
Full Name(s) of Sharemilker/Contract Milker
Type of Sharemilker/Contract Milker (please tick one)
Sole Trader
Partnership
Limited Partnership
Company
Trust
Estate
Details of Sharemilker/Contract Milker For a Sole Trader state full name. For Partnerships, state full names of all partners. For a Limited Partnership, state the full name of the General Partner(s). For Companies, state the full registered company name and company number. For Trusts, state the full names of all trustees. For Estates, state the full names of all executors.
Page 5 of 6 Form ID: FIM F10/1
Supplier Application Form Milk
3. Acknowledgement and Consent to be a Shareholder Information By signing this form, I/we confirm that the information in this form is true and correct and the property is to be used for dairying by me/us. I/we accept that if any of the information is not correct my/our supply of milk to Westland Milk Products could be terminated. Consent to be a shareholder I/we agree to be bound, as a Supplying Shareholder, by Westland Milk Products Constitution, the Terms and Conditions of Supply, the Suppliers Handbook and any other policies relating to the supply of milk made by Westland Milk Products Board (as amended from time to time). I/we have received and read the current Investment Statement relating to the Shares. I/we declare that: I give the Company my consent under the Privacy Act 1993 to obtain from - the Ministry for Primary Industry (the body responsible for enforcing compliance under the Animal Welfare Act 1999 and all relevant Codes and Regulations thereunder) all information about me/us relating to animal welfare - the body responsible for enforcing compliance under the Resource Management Act 1991 and all relevant Regulations thereunder, all information about me/us relating to resource management compliance - other milk processors to whom I/we have previously supplied milk, all information relevant to my application, including but not limited to, information about any termination of my supply of milk to that milk processor and the reasons for any such termination. I have not deliberately failed to disclose any matter, which may materially influence any decision to accept my/our supply of milk, which includes but is not limited to the above matters concerning animal welfare and resource management compliance. Agreement with Other Companies Monthly debtors are deducted from your milk payment before monies are paid to your bank account on the 20th of each month. Monies Payable I/we agree that all monies due by me/us to Westland Milk Products are payable upon demand and are immediately due and payable in the event that I/we cease supplying milk. Interest I/we agree that I/we will pay interest to Westland Milk Products on all monies owed to Westland Milk Products which are overdue at the rate that Westland Milk Products may determine from time to time. I/we also agree to pay all legal costs and other costs incurred by Westland Milk Products in collecting any monies outstanding.
Signed by the Applicant By signing this form I/we represent and warrant that I am/we are authorised to sign on behalf of the Applicant named above. Signature
Full name Date
Signature
Full name Date Acceptance of Application The Board may in its absolute discretion decide whether or not to accept an application to become a shareholder. Notification Upon receipt and process of your completed and signed application, we will advise you whether or not your application has been accepted. Please contact the Supplier Payments Officer should you not receive this letter within one month of the date of this application. An incomplete application may delay the processing of your application.
Page 6 of 6 Form ID: FIM F10/1
