Self-Declaration Form for 8 per cent Rebate on Electricity Bill

 

Mandatory fields are indicated with a red asterisk (*) 

You may be eligibile to receive an 8% rebate on your electricity bill effective January 1, 2017 under the Ontario Rebate for Electricity Consumers Act, 2016. If your account meets any of the eligibility criteria below, please check off all boxes that apply, and sign and date the form. Once completed, please submit the online form or return a hard copy to Energy+Inc. as per the instructions below. 

If you qualify for the rebate, we will retroactively credit your account (as applicable) to consumption effective January 1, 2017 or to a maximum of two years from the date you provided us with the completed self-declaration form, if submitted after January 1, 2019. 

Eligibility for the 8% rebate

To be eligible to receive the 8% rebate on your electricity bill, you must qualify for at least ONE of the following criteria: 

     (i) a property, within the meaning of the Condominium Act, 1998

  (ii) a residential complex, within the meaning of subsection 2 (1) of the Residential Tenancies Act, 2006, without regard to section 5 of that Act, or 

* Note:  If you are a hotel or motel and are claiming eligibility under (ii) above, you are certifying that you have a premise where people pay rent in return for full-time exclusive residence.   You certify that while you may have living accommodation intended to be provided to the travelling or vacationing public or occupied for a seasonal or temporary period in a hotel, motel or motor hotel, resort, lodge, tourist camp, cottage or cabin establishment, inn, campground, trailer park, tourist home, bed and breakfast vacation establishment or vacation home, the business/facility certifies the account has at least one unit that is a permanent residence, the occupant pays for the right of exclusive possession where any termination of the occupant must be in accordance with the Residential Tenancies Act.

     (iii) a property that includes one or more housing units and that is owned or leased by a co-operative within the meaning of the Co-operative Corporations Act.

You can find these acts on the government's e-laws website at www.e-laws.gov.on.ca

Acknowledgement

By completing this form, you are certifiying that information contained herein is accurate and you will notify Energy+ Inc. in writing if any information changes. You may be subject to a third-party audit at any time to verify the information. You also acknowledge that failure to do so will lead to the requirement to reimburse any overpayment.

The following individuals represent they have authority to provide and certify the accuracy of the information on this form. It is an offence to make a false or deceptive statement in a document submitted under the Ontario Rebate for Electricity Consumers Act, 2016. Please complete the applicable section below:

Certification

The following individuals have the authority to provide and certify the accuracy of the information provided on this form and any additional attachments. Please fill out the applicable sections. 

Clear
Clear
Clear

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

All information submitted in this process will be used by Energy+ Inc. in support of its obligations under the Ontario Rebate for Electricity Consumers Act, 2016; Electricty Act, 1998; applicable Ontario Energy Board Codes and Rules; associated policies; standards and procedures; and its license. Energy+ Inc. will use the information collected on this form for the purposes of confirming your eligibility for the 8% rebate to your bill and for auditing purposes. 

If you have any questions about this collection, the ways in which your personal information may be used by Energy+Inc., or would like further information about Energy+ Inc's privacy policy, please visit our website www.energyplus.ca.

Any penalty or action resulting from false declaration shall be borne by the customer. 

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.

Please return this form as soon as possible to:

Mail:

Energy+ Inc.

Attention: Customer Care

P.O. Box 1060, 1500 Bishop St. N.

Cambridge, Ontario

N1R 5X6

Email: CustomerCare@EnergyPlus.ca

Fax Number: 519-621-7420