AgriStability: Appeal Submission Form

You can use either the Web version or another version of the form from the Alternative Formats section.

Please complete, print and send the form by mail or fax.

Please use this form to submit an appeal to the AgriStability Program. It is very important to note that this form should not be used to request an adjustment. To request an adjustment, use form T1275 - AgriStability and AgriInvest Programs Additional Information and Adjustment Request.


Protected B when completed

Indicate the program year(s) for which you are submitting the appeal:

Section 1 - Personal Information

If this appeal is being submitted on behalf of a partnership or combined operation, please provide the names of all the appellants included in this appeal. Note: Shareholders of a corporation do not have to be listed.

Name of Co-appellantParticipant Identification Number (PIN)

Section 2 - Representative's Information

If you are submitting this appeal on someone else's behalf, complete the section below:

Privacy and Consent Clause

Agriculture and Agri-Food Canada (AAFC) is committed to protecting the privacy of your information. The information on this form, including your Participant Identification Number (PIN) is collected under the authority of Section 4 of the Farm Income Protection Act (FIPA) and will be used by the Administration and Appeal Committee members (including producer representatives and representatives from provincial or territorial governments) exclusively for the purposes of reviewing your appeal request and determining your eligibility for benefits. Your personal information will not be used for any other purpose except as required by law.

You have the right to request access to your personal information held by AAFC and to request changes to incorrect personal information. For more information about your rights under the Privacy Act, contact the AAFC Access to Information Privacy Coordinator at ATIP-AIPRP@agr.gc.ca and reference AAFC PPU 183.

In addition, by submitting this form for benefits under the AgriStability and AgriInvest programs, you:

  1. Certify that the information provided is complete and correct; and
  2. Understand that it is a criminal offence to make a false statement in application for program benefits and any declarations made are subject to audit.

Section 3 - Nature of Appeal

If the nature of the appeal is a missed deadline, please complete Box A.
For all other appeals, please complete Box B.
Note: An appeal request must be submitted within 90 days from the notification of the rejection of your adjustment request or within 90 days from the notification of a decision which is subject to appeal.

Box A - Missed Deadline

If you missed a deadline as a result of exceptional circumstances outside your control, please indicate the deadline that you missed, and explain the reason for missing the deadline. If you believe you met a deadline, but the Administration has indicated it does not have a record of this, please describe the actions you took to meet the deadline and any evidence you have of your actions.

For a list of exceptional circumstances considered to be reasonable grounds for missing a deadline, see the AgriStability Extenuating Circumstances Criteria.

Box B - Program Treatment

If you are of the view that program rules were not correctly applied in the processing of your application, you may request a review. Program rules are outlined in the Program Guidelines. Rules are also published in the Program Handbook.

In the space below, please explain which program rules you believe the Administration did not apply correctly in processing your application. Note: Disagreement with program rules is not valid grounds for appeal.

Section 4 - Documentation

You may wish to provide supporting documentation for your appeal - examples would include copies of benefit notices or other correspondence with the Administration, or evidence of circumstances related to missed deadlines. If you are attaching any documentation for this appeal, please list the documents in the box below. Please mark the front page of each document with the number you assign it to on the list.


Limit 400 Characters. Please attach a separate page if you need more space.
More documents

Limit 400 Characters. Please attach a separate page if you need more space.

Limit 400 Characters. Please attach a separate page if you need more space.

Limit 400 Characters. Please attach a separate page if you need more space.

Limit 400 Characters. Please attach a separate page if you need more space.

Limit 400 Characters. Please attach a separate page if you need more space.

Limit 400 Characters. Please attach a separate page if you need more space.

Limit 400 Characters. Please attach a separate page if you need more space.

Limit 400 Characters. Please attach a separate page if you need more space.

Limit 400 Characters. Please attach a separate page if you need more space.


Alternative Formats

Help with Alternative Formats

AgriStability Program Appeal Submission Form (Excel Version, 69 KB)

AgriStability Program Appeal Submission Form (PDF Version, 23 KB)

Date modified: