HBH Programme Expression of Interest Form For Proxy Farmers And Primary Off-Takers First Name (required) Last Name (required) Phone number (required) Your Email (required) Your Address Line 1(required) Your Address Line 2 (required) State of Residence (required) Country (required) Kindly Enter Number of Lot/Lots For Selected Project(s) of Interest: 1. IRB HBH Farm Estate Agbala, Imo State. Number of Lot/Lots as a Proxy Farmer: Number of Lot/Lots as a Primary Off-taker: 2. KANUCO HBH Poulrty Farm Gwagwalada, Abuja. Number of Lot/Lots as a Proxy Farmer: Number of Lot/Lots as a Primary Off-taker: 3. MAIZE FARM AKACHELE VILLAGE, OBIMA, NSUKKA, ENUGU Number of Lot/Lots as a Proxy Farmer: [AkacheleNumberofLotLotsasaProxyFarmer] Number of Lot/Lots as a Primary Off-taker: [AkacheleNumberofLotLotsasaPrimaryOff-taker] Name of Person who introduced you: Phone number of Person who introduced you: Additional Comments