This form is used by Niagara Peninsula Energy Inc. to determine a customer's eligibility for the Ontario Electricity Rebate. Please refer to the instructions below. Name of Account Holder Account Number Service Address Phone Number Email Address I wish to receive the Ontario Electricity Rebate (OER) on my electricity account. My account relates to: Account Type A multi-unit complex that is predominantly residential (e.g. condominium or apartment building), other than a retirement residence Any common elements of a multi-unit complex that is predominantly residential A retirement residence A mobile home park Multi-Unit Complexes Multi-unit complexes that are predominantly 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. Multi-unit options My Account relates solely to a multi-unit complex The multi-unit complex has at least two qualifying units At least 50% of the total number of units in the complex are qualifying units Common Elements of Residential Multi-Unit Complexes such as Condominium or Apartment Buildings These residences 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. Multi-Unit Options2 My account relates at least partly to common elements of a multi-unit complex 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 At least 50 per cent 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 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. Retirement Residence Options 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 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 Mobile Home Parks Starting July 1, 2022, accounts for a mobile home park will be eligible for the OER. Mobile Homes Please check the box to confirm it applies to your account. General You must check each box below and sign the form for your OER claim to be processed. General option Confirm that my account does not relate in whole or in part to any of the following types of excluded premises: General requirements 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 accomodation occupied by a person for a penal or correctional purposes A hospital A premise that is subjected to the ministry of correctional services act or the child, youth and family services act, 2017 Short-term living accomodation provided by an educational institution to its students or staff where, the living accomodation is provided primarily to persons under the age of majority, or all major questions related to the living accomodation are decided after consulation with a council or association representing the residents, and the living accomodation is not intended for year-round occupancy by full-time students or staff and members of their households A university, college of applied arts and technology or other entity that provides post-secondary education A premise 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) General acknowledgement Acknowledge 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 Confirmation I confirm that should my account cease to meet the eligibility requirements I will give a revised Notice to Niagara Peninsula Energy Inc. within 90 days of the date when the change in eligibility occurred. Name of Account Holder (or an individual legally authorized by the account-holder to give this Notice on the account-holder's behalf) Signature (Sign by typing name) Date
