From: Transport Canada
The federal Incentives for Zero-Emission Vehicles (iZEV) Program provides point-of-sale incentives on eligible zero-emission vehicles. To do this, participating dealerships agree to lower the purchase or lease price of eligible zero-emission vehicles and apply to the iZEV Program for a grant on behalf of the purchaser or lessee. In order to apply for this grant, dealerships are required to share certain purchaser of lessee personal information with Transport Canada to support the administration of the iZEV Program.
, hereby authorize
[participating dealership name] to collect my personal information provided to the dealership and provide that information to Her Majesty the Queen in right of Canada as represented by the Minister of Transport (“Canada”).
I further hereby consent and authorize Canada to:
This information is collected by Transport Canada for the purpose of:
The personal information provided by the dealership as part of the grant application and related documents is collected for the iZEV Program, under the authority of section 5 of the Canada Transportation Act.
The completion of this form is voluntary; however, it must be completed to be considered for a grant under the iZEV Program.
The personal information collected is described in a Personal Information Bank entitled Incentives for Zero-Emission Vehicles Program (bank number TC PPU 024). Under the provisions of the Privacy Act, individuals have the right of access to, correction of and protection 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.
I agree that my authorization is perpetual.
I hereby release Her Majesty the Queen in right of Canada, her agents, officers, employees, contractors, successors, and assigns from any claims, liability, damages, action or causes of action arising from or relating to the information and its use.
I am signing this iZEV Program Consumer Consent Form of my own free will, and have a full understanding and comprehension of its terms.
Printed Name of Eligible Vehicle Purchaser/Lessee
Date of Birth (dd-mm-yyyy) (for individuals)
iZEV Program consumer consent form
(PDF, 272 KB)