Постановление правительства Воронежской области от 15.02.2017 № 117

Справка
о размере целевых средств
Страхование сельскохозяйственных животных в    ------------------- году
(сельскохозяйственный товаропроизводитель - получатель субсидии)
Наименование страховой организации, с которой заключен договор сельскохозяйственного страхования с государственной поддержкой:

Номер договора страхования:

Дата заключения

№ строки

Наименование показателя

Наименование вида сельскохозяйственных животных согласно Плану сельскохозяйственного страхования на 2017 год, при проведении страхования которых предоставляются субсидии:

Крупный рогатый скот (искл. телят в возрасте                  до 2-х мес.)

Мелкий рогатый скот      (искл. козлят/ягнят в возрасте до 4-х мес.)Свиньи (искл. поросят в возрасте до 4-х нед.) Птица яйценоских и мясных пород, цыплята-бройлеры Прочие сельскохозяйственные животные * Семьи пчел Всего

Всего

в том числе по половозрастным группам

Всегов том числе по половозрастным группам Всего в том числе по половозрастным группам Всего в том числе: Всего в том числе по половозрастным группам

по половозрастным группам

цыплята-бройлеры

1

2

3

4

5

6

7

8

910 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37

1

Общее поголовье животных, страхование которых подлежит государственной поддержке (голов/ пчелосемей)

Х

2

Поголовье застрахованных животных (голов/ пчелосемей)

Х

3

Страховая стоимость (рублей)

4

Страховая сумма (рублей)

5

Страховой тариф (%)

Х

Х             Х             Х             Х           Х

6

Участие страхователя в страховании рисков (%)

Х

Х             Х             Х             Х           Х

7

Начисленная страховая премия (рублей)

8

Сумма уплаченной страховой премии (страхового взноса) (рублей)

9

Предельный размер ставки для расчета размера субсидий (%)

Х

Х             Х             Х             Х           Х

10

Размер страховой премии, подлежащей субсидированию (рублей):

Х

Х

Х

Х

Х

Х

ХХ Х Х Х Х Х Х Х Х Х Х Х Х Х Х Х Х Х Х Х Х Х Х Х Х Х X Х

10а

при условии, что страховой тариф не превышает или равен предельному размеру ставки для расчета размера субсидий (стр. 7)

10б

при условии, что страховой тариф превышает предельный размер ставки для расчета размера субсидий (стр. 4 х стр. 9 / 100)

11

Размер субсидий за счет средств федерального бюджета или областного бюджета, рублей

* лошади (за исключением молодняка в возрасте до 4-х месяцев) или кролики и пушные звери (за исключением молодняка в возрасте до 4-х месяцев)                                                                                                                                                                                                       

Получатель:                                                                                                                                                                                                                                 

ИНН/КПП:                                                                                                                                                                                                                                  

р/с:                                                                                                                                                                                                                                               

к/с:                                                                                                                                                                                                                                               

БИК                                                                                                                                                                                                                                             

Руководитель сельскохозяйственной организации                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        

(Глава крестьянского (фермерского) хозяйства)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           /   /

                                                                                                                                                                                                                                                                                                                                                                                                                                                             (Подпись)       (Расшифровка подписи)

Главный бухгалтер                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 /   /

                                                                                                                                                                                                                                                                                                                                                                                                                                                             (Подпись)       (Расшифровка подписи)

Дата                                     "                                                "                                                                                             20                  17                  г.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     

                                                                                                                                                                                                                                                       (      м.п.)                                                                                                                                                                                                    

Руководитель департамента                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  (Расшифровка подписи)

аграрной политики Воронежской области                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       (Подпись)                                                                                                                                                                                                                     

(или лицо, им уполномоченное)                                                                                                                                                                                                                                                                                                                                                                                                  (м.п.)