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Self-Declaration Form for Ontario Electricity Rebate

INSTRUCTIONS:

The Ontario Electricity Rebate (OER) is a provincially-funded rebate that applies as a credit on qualifying electricity bills. The following types of electricity accounts are eligible:

Low volume accounts (meaning the account has a demand for electricity of 50 kilowatts or less, or uses no more than 250,000 kilowatt hours of electricity per year); this includes most single-family homes and many small businesses
Farms
Long-term care homes
Multi-unit complexes that are predominantly residential, such as condominium and apartment buildings
Common elements in multi-unit complexes that are predominantly residential (as of July 1, 2022)
Retirement residences (as of July 1, 2022)
Mobile home parks (as of July 1, 2022).

In addition, some accounts that are not eligible but were receiving the former 8% Provincial Rebate that was in place before the OER was introduced on November 1, 2019 receive the OER under a legacy exemption.

You should complete this form only if your account relates to:

A multi-unit complex
Any common elements of a multi-unit complex
A retirement residence
A mobile home park.

If your account is a low volume account or relates to a farm or a long-term care home, you do not need to submit this form - you are entitled to receive the OER automatically. If you have one of these accounts but you are not already receiving the OER, please contact us. If you are unsure whether you are already receiving the OER, check your last bill.

NOTE: COMMERCIAL ACCOUNTS THAT ARE GREATER THAN 50kW, BUT USE LESS THAN 250,000 KILOWATT HOURS ANNUALLY, AUTOMATICALLY QUALIFY.

ELIGIBILITY CRITERIA FOR THE ONTARIO ELECTRICITY REBATE

DOES YOUR ACCOUNT QUALIFY?

I wish to receive the Ontario Electricity Rebate (OER) on my electricity account. My account relates to (please check one box below):

A multi-unit complex that is predominantly residential (e.g. a condominium or apartment building), other than a retirement residence. [If you check this box, fill out Part 1 and Part 5 below].

Any common elements of a multi-unit complex that is predominantly residential. [If you checked this box, fill out Part 2 and Part 5 below].

A retirement residence. [If you checked this box, fill out Part 3 and Part 5 below].

A mobile home park. [If you checked this box, fill out Part 4 and Part 5 below].

PART 1: MULTI-UNIT COMPLEXES

Multi-unit complexes that are predominately residential, such as condominium and apartment buildings, are eligible for the OER. To qualify, each of the three statements below must apply.

Please check the box next to each statement to confirm it applies to your account. If your account relates to a retirement residence or a mobile home park, do not complete this Part 1; skip to Part 3 or Part 4 as applicable.

1. My account relates solely to a multi-unit complex. (See note 1).

2. The multi-unit complex has at least two qualifying units. (See note 2).

3. At least 50% of the total number of units in the complex are qualifying units.

¹ A "multi-unit complex" is defined for OER purposes as a "building or related group of buildings containing two or more units. A "unit" is a) a unit defined in the Condominium Act, 1998, b) a residential unit or rental unit, as those terms are defined in subsection (1) of the Residential Tenancies Act, 2006, c) a member unit or non-member unit, as those terms are defined in the Co-operative Corporations Act, or d) premises that are demised premises for the purposes of the Commercial Tenancies Act; but does not include a unit that is used or intended for parking or storage purposes or for the purpose of providing space for services, recreation or other facilities or mechanical installations.

² A "qualifying unit" is defined for OER purposes as "a unit that a) consists of a self-contained room or set of rooms b) contains kitchen and bathroom facilities that are for the sole use of the unit, and c) is occupied and used as a residence."

PART 2: COMMON ELEMENTS OF RESIDENTIAL MULTI-UNIT COMPLEXES SUCH AS CONDOMINIUM OR APARTMENT BUILDINGS

Starting July 1, 2022, accounts for any common elements of a multi-unit complex that is predominantly residential are eligible for the OER.

To qualify, each of the three statements below must apply.

My account relates at least partly to common elements of a multi-unit complex. See note 3.

The multi-unit complex, including any part of the multi-unit complex to which the common area account does not apply, contains at least two qualifying units. See note 4.

At least 50 percent of the units within the multi-unit complex including any part of the multi-unit complex, to which the account does not apply, are qualifying units.

³ "Common elements" are defined for OER purposes as "any part of the multi-unit complex that is not a unit". See note 1 for the definitions of "multi-unit complex" and "unit".

⁴ See note 2 for the definition of "qualifying unit".

PART 3: RETIREMENT RESIDENCES

Starting July 1, 2022, accounts for a retirement residence will be eligible for the OER. To qualify, each of the four statements below must apply.

Please check the box next to each statement to confirm it applies to your account.

My account relates solely to a retirement residence.

At least 50 per cent of the units in the facility are occupied or intended to be occupied as a permanent residence by at least one person who is 65 years of age or older and who is not related to the operator of the facility. See note 5.

There are at least six persons aged 65 or older who occupy or are intended to occupy the facility.

The facility is NOT a long-term care home. [If it is, your account may still qualify; please contact us].

⁵ See note 1 for definition of a "unit".

PART 4: MOBILE HOME PARKS

Starting July 1, 2022, accounts for a mobile home park will be eligible for the OER.

Please check the box below to confirm it applies to your account.

My account relates solely to a mobile home park. See note 6.

⁶ A mobile home park is defined for OER purposes as "the land on which one or more occupied mobile homes are located and includes the rental units and the land, structures, services and facilities of which the landlord retains possession and that are intended for the common use and enjoyment of the tenants of the landlord". A "mobile home" is a dwelling that is designed to be made mobile and that is being used as a permanent residence". Trailer parks are not mobile home parks and do not qualify for the OER.

PART 5: GENERAL

You must check each box below and sign the form for your OER claim to be processed.

1. I can confirm that my account does NOT relate in whole or in part to any of the following types of excluded premises.

A hotel, motel or motor hotel, resort, lodge, tourist camp, cottage or cabin establishment, inn, campground, tourist home, bed and breakfast vacation establishment or vacation home.
A trailer park that is not a mobile home park.
Living accommodation occupied by a person for penal or correctional purposes.
A hospital.
A premises that is subject to the Ministry of Correctional Services Act or the Child, Youth and Family Services Act, 2017.
Short-term living accommodation provided as emergency shelter.
Living accommocation provided by an educational institution to its students or staff where, i) the living accommodation is provided primarily to persons under the age of majority, or all major questions related to the living accommodation are decided after consultation with a council or association representing the residents, and ii) the living accommodation is not intended for year-round occupancy by full-time students or staff and members of their household.
A university, college or applied arts and technology or other entity that provides post-secondary education.
A premises that is identified by a NAICS code commencing with the digits 21,22,23,31,32 or 33 ("NAICS" means the North American Industry Classification System maintained by Statistics Canada; the codes starting with the digits above relate to premises that include mining, quarrying, oil and gas extraction, utilities, construction and manufacturing).

Please check this box to acknowledge the following:

2. I acknowledge that it is an offence to make a false or deceptive statement in a document submitted under the Ontario Rebate for Electricity Consumers Act, 2016 and certify that the information herein is complete and accurate.

Please check this box to confirm the following:

3. I confirm that should my account cease to meet the eligibility requirements, I will give a revised notice to GrandBridge Energy (formerly Energy+) within 90 days of the date when the change in eligibility occurred.

ACCOUNT INFORMATION

If you have more than one qualified account, please use a separate declaration form for each account. If there are units in your building or complex that are metered or billed separately from the account referenced, do not include them in the total number of units for this account:

GrandBridge Energy (formerly Energy+) Account Number:

Account Name:

Service Address

Total Number of Units in Complex

Contact Phone Number:

Contact Email Address:

CONSENT TO THE RELEASE OF INFORMATION

I hereby consent to GrandBridge Energy (formerly Energy+) providing the following information to the Minister of Energy, Northern Development and Mines;

Account Name (unless the account is in the name of an individual).
Eligibility Criteria.
Whether the account is in respect of a hospital or a university, college of applied arts and technology or other entity that provides post-secondary education.

NOTIFICATION OF CHANGE IN ELIGIBILITY

If the account ceases to meet the eligibility requirements, an authorized officer of the company will provide notice of the change in eligibility, through submission of this form with the changed information, within 90 days of the change.

TO BE COMPLETED BY ALL APPLICANTS

I hereby certify that the information contained in this notice is complete and accurate.

I acknowledge that it is an offence to make a false or deceptive statement in a document submitted under the Ontario Rebate for Electricity Consumers Act, 2016.

I confirm the account may be subject to a third-party audit at any time to verify the accuracy of information provided and could be held liable for reimbursement of any funds overpaid.

Name / Title of Authorized Officer:

Signature of Authorized Officer: (I have legal authority to bind the Corporation)

Clear

Date:

Phone Number:

Email:

By completing the above information, I certify the information to be true, correct and complete.

You may submit this form online, by clicking the Submit button, or print a copy of this form and submit by mail, email, or fax to:

Mail:

GrandBridge Energy (formerly Energy+)

Attention: Customer Care

P.O. Box 1060, 39 Glebe Street

Cambridge, Ontario

N1R 5X6

HAVE QUESTIONS ABOUT THIS DECLARATION FORM?

Contact the Customer Care Department, Monday through Friday between 8:30 am and 4:30 pm. Contact us at seniorcc@grandbridgeenergy.com or 519-621-3530

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