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AgriStability and AgriInvest: Additional Contact Person Form (AgriStability)

You can use either the Web version below or the PDF (222 KB). Please complete, print and send the form by mail or fax.

Protected B when complete

Your Primary contact person is the person you identified on your AgriStability and AgriInvest form to provide and receive information on your behalf. We automatically update this information each year when you complete your AgriStability and AgriInvest form.

Complete this form to add or remove a contact person in addition to your Primary contact person. Your authorization is in place until you send in a new form to remove their name.

An Additional contact person can:

An Additional contact person cannot:

For AgriStability:

For AgriInvest:

Section 1 - Participant information

Section 2 - Confidential information and participant consent

You or an authorized representative (if the participant is an entity) must sign this form. An authorized representative is an owner, officer or director of the entity.

Agriculture and Agri-Food Canada (AAFC) is committed to protecting the privacy of your information. The information on this form is collected under the authority of Section 4 of the Farm Income Protection Act and will be used to administer your participation in the AgriStability and AgriInvest programs.

By providing an additional contact person’s name, you are authorizing both the AgriStability and AgriInvest Administrations to receive information from and to disclose information to the additional contact person, and to make changes to your applications as directed by them.

Print name of authorized representative:

Signature (Participant or authorized representative):

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 aafc.atip-aiprp.aac@canada.ca and reference AAFC PPU 183 and/or CRA PPU 005.

Section 3 - Additional contact person information

Additional contact person

Select one:

Add Remove

Program(s): AgriStability AgriInvest Both

Section 4 - Send your completed form

Mail or fax

AgriStability and AgriInvest
PO Box 3200
Winnipeg MB R3C 5R7
Toll free fax: 1-877-949-4885

Questions?

Call us toll free at 1-866-367-8506
Monday to Friday, 8:00 am to 5:00 pm (CDT)

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