Declaration to Apply for Year-Round Residential Rate Status Form

Customer Information

Name:

Email:

Is this declaration for more than one person?

Yes No

Name of Second Acount Owner:

Email of Second Account Owner:

I/We certify that all of the facts stated below are true and correct and that this Declaration is made for the purposes of assisting Hydro One Networks Inc.'s determination as to my/our entitlement to year-round rate status.

I/We am/are the:
Sole Owner Joint Owner Tenant(s)

For the dwelling located at:

Account Number: Note: Must start with "29" and have 12 digits in total

Meter Number: Note: Meter number must start with "J" followed by 7 digits to be valid

Supporting Document GIF / JPG / JPEG / PDF / PNG

Please attach a scanned copy of your driver's licence here. If you do not have a driver's licence, please submit another form of proof of residence and ensure you block out any financial or other personal information other than your name and address.

Certification

I/We meet all of the following criteria:

I/We represent and warrant that for as long as I/we have year-round residential rate status for this dwelling, I/we will not designate another property that I/we own as a year-round residence for the purpose of Hydro One's rate classification.
The residence is the one in which I/we reside for at least four days of the week for eight months of the year and I/we do not reside anywhere else for more than three days a week during eight months of the year.
The address of this residence appears on my/our supporting documents such as my/our driver's licence, credit card invoices, property tax bill, etc.
If I/we are eligible to vote in provincial or federal elections, I/we must be enumerated for voting purposes at the address of this residence.

I/We understand Hydro One networks Inc.'s decision with respect to entitlement is final. Furthermore, if I/we have made any false statements on this form, Hydro One Networks Inc. is entitled to immediate repayment of the difference between the rates and charges I/we paid as a result of claiming to qualify for year-round residential status and the rates and charges I/we would have paid if I/we did not qualify therefore, plus interest at the rates Hydro One Networks Inc. uses on bill adjustments.

I/We understand that in order to maintain the confidentiality of my/our information, your distribution license requires that you not disclose any of my/our information to a third party without my/our consent in writing, except where it is required to be disclosed to (a) meet legal and regulatory requirements; (b) inform me/us about the electricity market and rates (c) for law enforcement purposes; (d) process past due accounts; or (e) billing and market operation purposes.

To the best of my knowledge, the information contained in this form is accurate and complete.