iMHZEV Program organization consent form

The federal Incentives for Medium- and Heavy-duty Zero-Emission Vehicles (iMHZEV) Program provides point-of-sale incentives on eligible medium- and heavy-duty zero-emission vehicles (MHZEVs). To do this, participating dealerships and authorized sellers agree to lower the purchase or lease price of eligible MHZEVs and apply to the iMHZEV Program for a grant on account of the incentives given to eligible organizations. In order to apply for this grant, dealerships and authorized sellers are required to share the organizational information of purchasers or lessees with Transport Canada to support the administration of the iMHZEV Program.

I, [authorized representative of purchasing/leasing organization], hereby authorize [participating dealership/authorized seller name] to collect the organization’s information provided to the dealership/authorized seller and provide that information to His Majesty the King in Right of Canada, as represented by the Minister of Transport (“Canada”).

I further hereby consent and authorize Canada to:

1. collect the organization’s information provided to the dealership/authorized seller;
2. store the organization’s information as set out below;
3. use the organization’s information provided to the participating dealership/authorized seller for the purposes of receiving the federal incentive under the iMHZEV Program and for the purposes outlined below; and
4. validate the organization’s 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:

1. administering the iMHZEV Program, which includes but is not limited to determining the eligibility for a grant under the iMHZEV Program, such as Canadian presence requirements, limits of eligible incentives and other criteria published on the Transport Canada website;
2. evaluating the iMHZEV Program, and informing any of Canada’s future program policies related to MHZEVs;
3. validating eligible MHZEV purchases/leases, which includes the vehicle identification number, province, postal code of the purchaser / lessee with the Canadian Council of Motor Transport Administrators; and

The organization’s information provided by the dealership/authorized seller as part of the grant application and related documents is collected for the iMHZEV Program 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.  Any personal and/or organizational information provided to Transport Canada will be used and disclosed in accordance with the Privacy Act.

In consideration of the opportunity to participate in the iMHZEV Program, I 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 the organization’s information disclosed and its use or retention. I am signing this iMHZEV Program Organization Consent Form as a duly authorized representative, on behalf of the organization named below, and have a full understanding and comprehension of its terms.

Consent to be Contacted

By benefitting from the iMHZEV Program, I 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 iMHZEV Program and to inform future programs and policies related to zero-emission vehicles.

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

iMHZEV Program organization consent form
(PDF, 100 KB)