Field Registration Form

Farmer Information

Full Name:

ID Number:

Gender:

Male

Female

Other:

Date of Birth:

Contact Number:

Email (if available):

Marital Status

Single

Married

Widowed

Divorced

Other:

Dependents

Name	Relationship	Gender	Age	Action

Farm Location

District:

Council:

Ward:

Constituency:

Village:

GPS Coordinates:

Land Ownership and Title

Form of Land Ownership:

Individual Ownership

Family Ownership

Communal Land

Rented

Other:

Do you have a land title deed?

Yes

No

If Yes, Title Deed Number:

If No, what form of land rights do you have?

Duration of land possession/use (years):

Field Details

Total Farm Size (acres):

Size of Field Allocated for Potato Project (minimum 0.2 acres):

Latitude:

Longitude:

Altitude (if known):

Previous Crop History

Crop planted in this field last season:

Any known pest or disease issues in the past two years?

Yes

No

If yes, please specify:

Water Source

Rain-fed

Irrigation (specify type):

Soil Type and Potato Variety

Soil Type (if known):

Preferred Potato Variety (if any):

Experience with Potato Farming

First time

1-3 years

4-10 years

More than 10 years

Additional Information

Please provide any other relevant information about your field, farming practices, or household situation:

Declaration

I, , hereby declare that the information provided above is true and accurate. I understand that this information will be used for the purposes of the potato production project and agree to participate in accordance with the project guidelines.

Signature(Initials and Surname):

Date: