EVAP Consumer Consent Form

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The Electric Vehicle Affordability Program (EVAP) provides point-of-sale incentives on eligible electric vehicles (EVs). As such, participating dealerships agree to lower the purchase or lease price of eligible EVs and apply to the EVAP for a grant on behalf of the purchaser or lessee. To apply for this grant, participating dealerships are required to share the personal information of purchasers or lessees with Transport Canada to support the administration of the Program.

By completing the “Purchaser/Lessee Information (“Recipient”)” section below, I, the Recipient, authorize the participating dealership to collect or receive my personal information and provide that information to His Majesty the King in Right of Canada as represented by the Minister of Transport (“Canada”).

Purchaser/Lessee Information (“Recipient”)

TO BE COMPLETED IF YOU ARE BENEFITTING AS AN INDIVIDUAL
Recipient first name:	Recipient last name:
Recipient Date of Birth (individuals only – YYYY-MM-DD):	Participating dealership name:
TO BE COMPLETED IF YOU ARE BENEFITTING AS A BUSINESS OR ORGANIZATION
Authorized recipient representative first name:	Authorized representative last name:
Business name:	Participating dealership name:
Business number (e.g. 9 digit CRA number or other registration number):

Personal Information

I, the Recipient, further hereby consent and authorize Canada to:

1. collect or receive my personal information provided to or collected by the participating dealership;
2. store the personal information as set out below;
3. use the personal information provided to the participating dealership for the purposes of receiving the federal incentive under the EVAP and for the purposes outlined below; and
4. validate personal information with the Canadian Council of Motor Transport Administrators for the purposes set out below.

This information is collected by Canada for the purpose of:

• administering the EVAP, which includes but is not limited to determining the eligibility for a grant under the EVAP, auditing or evaluating the EVAP, and informing any of Canada’s future program policies related to electric vehicles (EVs); and
• validating eligible EV purchases, which includes the vehicle identification number, province, postal code (and date of birth for individuals) of the purchaser / lessee with the Canadian Council of Motor Transport Administrators.

The personal information provided by the participating dealership as part of the grant application and related documents is collected for the EVAP in accordance with the Minister of Transport’s mandate as described in section 5 of the Canada Transportation Act, and by virtue of the powers available under section 20 of the Motor Vehicle Safety Act, as well as in accordance with section 6.5 of the Treasury Board Directive on Transfer Payments. All personal information provided to Transport Canada will be used and disclosed in accordance with the Privacy Act.

The personal information collected is described in a Personal Information Bank entitled Incentives for Zero-Emission Vehicles Program (bank number TC-PPU-052). Under the provisions of the Privacy Act, individuals have the right to request access to, and correction of their personal information. Instructions for obtaining personal information are provided in Info Source, a copy of which is available in major public and academic libraries or online at http://www.infosource.gc.ca.

To report a privacy concern please visit https://www.priv.gc.ca/en/report-a-concern/file-a-formal-privacy-complaint/.

In consideration of the opportunity to participate in the EVAP, I, the Recipient, hereby release His Majesty the King in Right of Canada, his agents, officers, employees, contractors, successors, and assigns from any claims, liability, damages, action or causes of action arising from or relating to any act, omission or negligence, including wrongful management of my the personal information, by the participating dealership. This release does not affect rights and remedies afforded to the Recipient under the Privacy Act. I am signing this EVAP Consumer Consent Form of my own free will and have a full understanding and comprehension of its terms.

Consent to be Contacted

By benefitting from the EVAP, I, the Recipient, give permission to be contacted by Canada or its representatives by phone, email, or other electronic means (including surveys) with respect to my experience with the EVAP and to inform future programs and policies related to EVs.

If you prefer not to receive survey-related communications, please check the box below.

☐I, the Recipient, do not give permission to be contacted by Canada or its representatives by phone, email, or other electronic means for survey-related purposes with the EVAP to inform future programs and policies related to EVs.