Ontario Electricity Rebate Self-Declaration Form

E.L.K. Energy Inc. uses this form to determine a customer's eligibility for the Ontario Electricity Rebate ("OER"). 
Eligibility for the Ontario Electricity Rebate
To be eligible to receive the rebate, you must qualify under at least one of the following six criteria. 
Please check all that apply. 
To be eligible to receive the rebate, you must qualify under at least one of the following criteria:
  • A hotel, motel, 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 accommodation provided by an educational institution to its students or staff where:
    •  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
    • the living accommodation 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
  • Premises that is identified by a NAICS code commencing with the digits 21, 22, 23, 31, 32 or 33 (i.e. in the mining, quarrying, oil and gas extraction, utilities, construction and manufacturing sectors)
I consent to E.L.K. Energy Inc. disclosing the following information to the Ministry of Energy, Northern Development and Mines:

  • the name of the Account Holder (unless the account is in the name of an individual);
  • where applicable, the Farm Business Eligibility Criteria applicable to the Account; and
  • where applicable, the total consumption of electricity for the period May 1, 2018 to April 30, 2019.
I 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.

I confirm that should the account no longer meet the eligibility requirements I will give a revised declaration form to Hydro One within 90 days of the date when the change in eligibility occurred.
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