33 King Street West PO Box 642 Oshawa ON L1H 8T1
Ministry Receipt Date (for Ministry use only)
First Name Last Name Social Insurance Number Date of Birth (yyyy/mm/dd)
Unit/Apt/Suite Street Number and Name/Rural Route City/Town Province ON Postal Code
(If your principal residence address is the same as your mailing address, go to Section B; if it is different, complete the information below). Unit/Apt/Suite Street Number and Name/Rural Route City/Town Province ON Postal Code
You may be eligible for the credit if you meet all the following requirements:
Yes No (check one box only)
To receive the NOEC your Adjusted Family Net Income for 2009 must be less than $48,000 if you are single; or less than $65,000 if you are a family.
IMPORTANT: The credit will be paid in two instalments, the first in November 2010 and the second in February 2011. To be eligible for the first instalment, you must be a resident of northern Ontario on November 15, 2010. To be eligible for the second instalment, you must be a resident of northern Ontario on February 15, 2011. If you move after you file this application, you should notify the ministry immediately at 1 866 305-1954 or at the address provided.
We recommend that you use direct deposit. Please attach a blank cheque with “VOID” written on the front, OR have your financial institution complete a Direct Deposit form and attach it to this application.
I certify that the information provided on and with this form is correct. I understand that the personal information contained in and accompanying this form is being collected and the Ministry of Revenue and ServiceOntario, a part of the Ministry of Government Services, in connection with administering the Northern Ontario Energy Credit (NOEC) program. Administration of the NOEC includes, among other things, determining and verifying my eligibility, administering my payments, enforcing and resolving issues relating to the program. I consent to this collection and use by these ministries and to any sharing of this personal information for these purposes by these ministries with each other, and the Canada Revenue Agency.
I hereby consent to the release, by the Canada Revenue Agency to an official of the Ministry of Revenue and ServiceOntario, a part of the Ministry of Government Services, of income and expense information and related identifying information about me from my income tax records, whether supplied by me or a third party. This consent is provided on condition that this information may be used solely for the purpose of determining and verifying my eligibility for and entitlement to the Northern Ontario Energy Credit (NOEC) under the authority of the Taxation Act, 2007 and that it will not be disclosed to any other person or organization or used or disclosed for any other purpose without my written approval.
This authorization is valid for the 2009 taxation year and current dependant information for which assistance is requested by me or on my behalf.
I understand that if I wish to withdraw this consent, I may do so at any time by writing to the Ministry of Revenue, at the address provided.
Signature of Applicant Signature of Spouse or Common-Law Partner Date (yyyy/mm/dd)
For 2010, the Ministry of Revenue will process your application and determine if you are eligible for the credit.
An application submitted with missing or incomplete information will delay processing.
The maximum annual credit for a single individual is $130. It will be reduced by one cent for every dollar of Adjusted Family Net Income over $35,000.
The maximum annual credit for a family (including single parents) is $200. It will be reduced by one cent for every dollar of Adjusted Family Net Income over $45,000.
The 2010 credit will be paid in two instalments, the first in November 2010 and the second in February 2011.
If you move after you file this application, notify the ministry immediately by calling the toll free number or sending a letter to the address provided.
The deadline to apply for the 2010 credit is June 30, 2011.
For future years you can apply for the credit through your personal income tax return (T1) and, if you are eligible, the credit will be paid on a quarterly basis.
Northern Ontario means the territorial districts of :
Single means an individual who:
Family means:
Dependant child means an individual who:
Exception: A dependant child does not include a child for whom a special allowance under the Children’s Special Allowances Act (Canada) is payable.
Family Net Income is your net income at Line 236 of the personal income tax return (T1). If you have a spouse or common-law partner, their net income from their tax return is added to your net income to determine your Family Net Income.
Adjusted Family Net Income is your Family Net Income adjusted to exclude any amounts you or your spouse or common-law partner (if applicable) received from the Universal Child Care Benefit (UCCB) and the Registered Disability Savings Plan (RDSP). However, any UCCB or RDSP amount you or your spouse or common-law partner (if applicable) repaid will be included as part of your Adjusted Family Net Income.
You and your spouse or common-law partner (if applicable) must sign and date this application. An unsigned application will delay processing. Please include a daytime and evening telephone number where you can be reached.
Once your application is processed, you will receive an Entitlement Notice stating whether or not you are eligible for the credit. To ensure that you receive the Entitlement Notice, please notify us of any address change by calling the ministry at 1 866 305-1954 or sending a letter to the address provided.
Send your completed application to:
Ministry of Revenue 33 King Street West PO Box 642 Oshawa ON L1H 8T1
For more information about the Northern Ontario Energy Credit program call the Ministry Information Centre and/or visit the website:
Toll free 1 866 305-1954
Teletypewriter (TTY) 1 800 263-7776
Website ontario.ca/NorthernEnergyCredit
Email NOEC@ontario.ca
Or send a letter to the Ministry of Revenue, at the address shown above.
The personal information provided by you on this form is collected under the authority of the Taxation Act, 2007, S.O. 2007, c.11, Schedule A, Part V.6 and Part V.7, as amended, and will be used for the purpose of administering the NOEC program. Any questions regarding the collection, use and disclosure of the personal information under this Act should be directed to the Customer Care Representative at the Ministry of Revenue, 33 King Street West, PO Box 642, Oshawa ON L1H 8T1, 1 866 305-1954.