SCHEDULE 6APPLICATIONS FOR REGISTRATION AND REIMBURSEMENT — DAY CARE FOOD FOR CHILDREN IN DAY CARE

Information to be provided on application for remibursement2

a

Full name of person claiming reimbursement;

b

address where children are cared for;

c

name and address of person to whom payment is to be made;

d

period of claim;

e

number of day-care sessions each day;

f

number of children cared for on each day during period of claim;

g

the quantity, price and total cost of milk and infant formula consumed each month for the period of the claim.