iMHZEV - Incentive received forms

I, (print name of authorized representative of the purchasing or leasing organization), of (City), (Province/Territory), acting as an authorized representative and on behalf of (full legal name of purchasing or leasing organization name) (the “Organization”), which operates in (City), (Province/Territory), acknowledge that on the date of purchase or lease below, the Organization received an incentive from Transport Canada’s Incentives for Medium- and Heavy-duty Zero-Emission Vehicles (iMHZEV) Program in the amount of $ (federal incentive amount only), which is available to an eligible recipient organization who purchases or leases an eligible medium- or heavy-duty zero-emission vehicle. This incentive was deducted from the final purchase price, after taxes and fees, for the Organization’s new (year), (make), (model), (trim), (vehicle class), (battery size (kWh)), which was purchased / leased on (date of purchase or lease), from  (name of dealership/authorized seller).

I further acknowledge that I have signed and dated the iMHZEV Program Organization Consent Form and provided the iMHZEV Program Organization Consent Form to the dealership/authorized seller listed above.

I am authorized to make the following declarations on account of the incentive given to the Organization and declare that the Organization:

• has not received more than 10 incentives (or a maximum of $1,000,000) under the iMHZEV Program this calendar year, including the purchase(s) or lease(s) for which this form is completed;
• has not received combined incentives exceeding 75% of the vehicle’s MSRP for the purchase or lease in which this form is completed;
• cannot receive funding from Canada’s Zero-Emission Transit Fund for any vehicle for which the Organization has received an iMHZEV incentive; and
• may be asked for reimbursement, should the Organization be found to have received funding or incentives in breach of the terms above or in breach of any iMHZEV eligibility criteria published on the Transport Canada website.

Incentive Received Form for the iMHZEV Program
(PDF, 131 KB)