HSI Payment Form

HSI Payment Form

This form is not suitable for payment of registration services/passporting. This form is only suitable for the request of reimbursement through the Breeding Department (Breeding Grant funded classes, DAFM Studbook Series, DAFM Development Series). These initiatives and events are funded by the Department of Agriculture, Food and the Marine (DAFM) through National Breeding Services and delivered by Horse Sport Ireland
I am entitled to reimbursement through the Breeding Department for:*

Breeding Grant CompetitionDAFM Studbook Series (including Pony Series)DAFM Development SeriesLoose Jumping (CREAGH ONLY)Feedback section ONLY

Breeding Grant Competition

For competitions funded by the Breeding Grant Initiative
Show Name*
Date*

MonthDayYear
Date
Competition Location*
Class Name*
Placing*

Payment Details
Payee Status: Please indicate your status in relation to the horse details previously provided (i.e. breeder/owner/rider).*

BreederOwnerRider
Rider: Has the Owner provided written permission to HSI for you to claim prize money?

YesNo (I understand Payment will not be made if this is not received)
Payee Account Name*
Please provide Payee Name as it appears on the bank account
Payee IBAN*
Please provide Payee IBAN as it appears on the bank account. The IBAN MUST be for the Account Name provided
Payee Phone Number*
Payee Email*
example@example.com
Please enter your County of Residence*
If you chose 'OTHER' please detail:*
County of residence*
Please enter the county on your address.
HSI Finance Account Number
You should find this number on all previous remittances received from HSI. It will have 4 letter and 3 numbers i.e. ABCD123
Checklist*

I have checked my IBANI have provided the account name, for the IBAN providedI can confirm I am the owner/ authorised by the owner to collect this payment/ Will provide written permission where necessary
Applicants must be prepared to provide Horse Sport Ireland with a Tax clearance certificate should the sum of their approvals and or prize money equal €5,000 or more. If a tax clearance cert cannot be furnished on request, grants cannot be provided. CLICK HERE FOR INFORMATION ON HOW TO APPLY.

Breeding Grant Competition