From: Transport Canada Please download and use PDF to complete the form iZEV Incentive Received Forms (PDF, 182 KB) iZEV Program Incentive Received Form for Individuals I, (print name of purchaser or lessee), resident of (City), (Province/Territory), acknowledge that on the date of purchase or lease below, I received an incentive from Transport Canada’s Incentives for Zero-Emission Vehicles (iZEV) Program in the amount of $ (federal incentive amount only), which is available to an eligible recipient who purchases or leases an eligible zero emission vehicle. This incentive was deducted from the final purchase price, including taxes and fees, for my new: Year: Make: Model: Trim: which was purchased / leased on (date of purchase or lease (Year/Month/Day)) at (name of dealership). I further acknowledge that I have signed the iZEV Program Consumer Consent Form, and I have provided the iZEV Program Consumer Consent Form to the dealership above. I attest that I have not received an incentive under the iZEV Program during this calendar year, other than for the purchase or lease for which this form is completed. I represent that I will not seek to receive more than one incentive under the iZEV Program in any calendar year. I understand that should I be found to have received more than one incentive from the iZEV Program in a calendar year, the dealership(s) who provided the iZEV incentive(s) may seek to recover the amount of the incentive provided to me. I further represent that I will not seek to claim the proposed enhanced federal capital cost allowance for zero-emission vehicles announced in the 2019 federal budget for any vehicle for which I have received an iZEV incentive. I further acknowledge the federal iZEV incentive amount identified above has been applied directly towards the price of my new vehicle by the dealership, I did not have to make a deposit to receive the incentive, and the incentive will not be refunded to me, by cheque, at a later date. If this is the case, please write your situation at iZEV-iVZE@tc.gc.ca. Signature Date (Year/Month/Day) iZEV Program Incentive Received Form for Organizations I, (print name of authorized representative of the purchasing or leasing organization), acting as an authorized representative and on behalf of (City), (Province/Territory), acting as an authorized representative and on behalf 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 Zero-Emission Vehicles (iZEV) Program in the amount of $ (federal incentive amount only), which is available to an eligible recipient who purchases or leases an eligible zero-emission vehicle. This incentive was deducted off the final purchase price, including taxes and fees, for the Organization’s new: Year: Make: Model: Trim: which was purchased / leased on (date of purchase or lease (Year/Month/Day)) at (name of dealership). I further acknowledge that I have signed the iZEV Program Consumer Consent Form dated and provided the iZEV Program Consumer Consent Form to the dealership. I am authorized to make the following declarations on behalf of the Organization: The Organization has not received more than 10 incentives under the iZEV Program this calendar year, including the purchase(s) or lease(s) for which this form is completed; If the Organization is an approved Transport Canada carsharing company, has not received more than 50 incentives under the iZEV Program this calendar year, including the purchase(s) or lease(s) for which this form is completed. For the purpose of determining eligibility to the iZEV Program, the Organization acknowledges and agrees that any businesses sharing common ownership — except for those that are publicly traded companies — will be considered as one organization. Should the Organization be found to have received more than the eligible number of incentives from the iZEV Program in a calendar year, the Organization agrees that the dealership(s) who provided the iZEV incentive(s) may seek to recover the amount of the incentive(s) provided to the Organization; and The Organization cannot seek to claim the proposed, enhanced federal capital cost allowance for zero-emission vehicles announced in the 2019 federal budget for any vehicle for which the Organization has received an iZEV incentive. I further acknowledge the federal iZEV incentive amount identified above has been applied directly towards the price of my new vehicle by the dealership, I did not have to make a deposit to receive the incentive, and the incentive will not be refunded to me, by cheque, at a later date. If this is the case, please write your situation at iZEV-iVZE@tc.gc.ca. Signature Date (Year/Month/Day)