Licence serial number(s): *

 
As the Holder of the above licence(s), I would like to apply for my yearly charges for the licence(s), which authorises spray irrigation only to be charged under a two-part tariff arrangement, as set out in Schedule 2 of Natural Resources Wales’ Abstraction Charging Scheme.

I understand that this arrangement will stay in force for five years, and then every year after this. This arrangement may end sooner if:
  1. my licence comes to an end, is cancelled or is transferred to another person;
  2. I apply to you to end the agreement; or
  3. there is a change of circumstances, which allows you to end the agreement.

I declare that: