application to register for manufacturer, wholesaler, … · wholesaler, dyer, importer, exporter...

0504E (2013/07) © Queen's Printer for Ontario, 2013 Disponible en français of 6

Ministry of Finance 33 King St W PO Box 620 Oshawa ON L1H 8E9

Application to Register for Manufacturer, Wholesaler, Dyer, Importer, Exporter and Interjurisdictional Transporter Gasoline Tax Act and/or Fuel Tax ActEnquiries: 1 866 ONT-TAXS (1 866 668-8297)

1 800 263-7776 Teletypewriter (TTY)1. ApplicantLegal Name

Business or Trade Name Same as Legal Name Business No.

Language of Choice

English

French

2. Business AddressUnit/Apt/Suite Street Number and Name Lot/Concession/RR No./Postal Stn

City/Town Province/State Country Postal/Zip Code

(Area Code) Business Telephone No. Fax No. Email Address

3. Mailing Address Same as Business AddressUnit/Apt/Suite Street Number and Name Lot/Concession/RR No./Postal Stn


4. Head Office Address Same as Business Address Same as Mailing AddressUnit/Apt/Suite Street Number and Name Lot/Concession/RR No./Postal Stn


5. Type of Legal Entity Check R applicable box (one only):IndividualCorporationGeneral Partnership

Limited PartnershipLimited Liability PartnershipLimited Liability Company

AssociationCo-operativeJoint Venture

Non-Share CorporationTrust

6. List all Owners, Partners, Officers and/or DirectorsName (First, Last Name) Title (Area Code) Telephone No.

If insufficient space, attach list7. Contact Person(s)Name (First, Last Name) Title


Unit/Apt/Suite Street Number and Name/PO Box/Postal Stn/Rural Route City/Town Province/State Postal/Zip Code

Document(s) this contact person should receive. (Check R applicable boxes.)All or specify: Application Assessment Renewals Returns

Name (First, Last Name) Title


Unit/Apt/Suite Street Number and Name/PO Box/Postal Stn/Rural Route City/Town Province/State Postal/Zip Code

Document(s) this contact person should receive. (Check R applicable boxes.)All or specify: Application Assessment Renewals Returns

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8. Designation as a Collector and Manufacturer Registration CertificateComplete if you propose to manufacture and are applying for a Designation as a Collector and a Manufacturer Registration Certificate under the Gasoline Tax Act and/or Fuel Tax Act.

Gasoline Product TypeLitres Manufactured in the last 12 months

Estimated Litres to be Manufactured in the next 12 months

Gasoline

Ethanol Blended Gasoline

Denatured Fuel Ethanol

Aviation Fuel

Propane

Fuel Product Type

Clear Fuel

Coloured Fuel

Kerosene

Bio-Diesel

Manufacturing Plant(s) - For each location in Ontario, list the manufacturing plant details:

Name of Manufacturing Plant Address of Manufacturing Plant Type of Product Manufactured

Street No. and Name

City/Town Province Postal Code

Street No. and Name


Street No. and Name


If insufficient space, attach list

9. Designation as a CollectorComplete if you are a wholesaler or propose to wholesale and are applying for a Designation as a Collector under the Gasoline Tax Act and/or Fuel Tax Act.

Gasoline Product TypeLitres Manufactured in the last 12 months

Estimated Litres to be Manufactured in the next 12 months

Gasoline



Aviation Fuel

Propane

Fuel Product Type

Clear Fuel

Coloured Fuel

Kerosene

Bio-Diesel

Note: Sales at Wholesale = Sales to other wholesalers and/or retailers (not including your own service stations).

Is or will at least 51 per cent of your sales be at wholesale? . . . . . . Yes No

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10. Dyer Registration CertificateComplete if you propose to colour fuel and are applying for a Dyer Registration Certificate under the Fuel Tax Act. To qualify you must have:

i) terminal or northern terminal facilities, andii) total sales of coloured fuel from all proposed dye points owned or operated must be equal to or in excess of 51 per cent

of the collector’s total sales of coloured fuel during the 12 month period prior to application for a Dyer Registration Permit.“Terminal” qualifications: “A storage facility owned or operated by a collector that is capable of holding in storage fuel in bulk for subsequent sale by the collector to which not less than 70 per cent by volume of its receipts of fuel in each calendar year are transported or transferred by vessel or pipeline.”Terminals - Please list the location of each terminal:

Street No. and Name City/Town Province/State Postal/Zip Code


“Northern Terminal” qualifications: “A storage facility situated in Ontario north of 46 degrees north latitude, owned or operated by a collector, that is capable of holding middle distillate fuels in storage for subsequent sale by the collector, to which not less that 90 per cent by volume of its receipts of middle distillate fuels in any year are transported by rail tank car, each such tank car transporting not less than 70,000 litres of middle distillate fuels to the storage facility.”Northern Terminals - Please list the location of each northern terminal:



Does at least one of your Terminals listed above qualify as a proposed Dye Point? . . . . . Yes No

Dye Point Terminals - Please list the location of each terminal you propose to colour fuel as a Registered Dyer at:



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11. Bulk Storage Location - For each location in Ontario, list the bulk storage facility details:

Address of Storage Facility Product Type Stored

Storage Tank Capacity

Owned or Leased

Street No. and Name


Owned

Leased to Others

Leased from Others

Street No. and Name


Owned

Leased to Others

Leased from Others

Street No. and Name


Owned

Leased to Others

Leased from Others

Street No. and Name


Owned

Leased to Others

Leased from Others


12. Supplier Information - List supplier(s) that you will purchase or obtain gasoline and/or fuel from:Supplier Name Street No. and Name City/Town Province/State Postal/Zip Code


13. Importer Registration CertificateComplete if you import or propose to import gasoline and/or fuel products in bulk into Ontario and are applying for an Importer Registration Certificate under the Gasoline Tax Act and/or Fuel Tax Act.List the details for each Gasoline and/or Fuel Type purchased below:

Gasoline Product TypeLitres Imported

in the last 12 monthsEstimated Litres to be imported

in the next 12 months Jurisdiction Product Imported from (Province/State/Country)

Gasoline



Aviation Fuel

Propane

Fuel Product Type

Clear Fuel

Coloured Fuel

Kerosene

Bio-Diesel

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14. Exporter Registration Certificate

Complete if you propose to export gasoline and/or fuel products in bulk out of Ontario and are applying for an Exporter Registration Certificate under the Gasoline Tax Act and/or Fuel Tax Act.

List the details for each Gasoline and/or Fuel Type purchased below:

Gasoline Product TypeLitres Exported

in the last 12 monthsEstimated Litres to be Exported

in the next 12 months Jurisdiction Product Exported

to (Province/State/Country)

Gasoline



Aviation Fuel

Propane

Fuel Product Type

Clear Fuel

Coloured Fuel

Kerosene

Bio-Diesel

15. Common Carrier Information - List transporter(s) who will transport your product(s) into and/or out of Ontario below:

Name of Transporter Street No. and Name City/Town Province/State Postal/Zip Code


16. Interjurisdictional Transporter Registration CertificateComplete if you propose to transport gasoline and/or fuel products in bulk into and/or out of Ontario and are applying for an Interjurisdictional Transporter Registration Certificate under the Gasoline Tax Act and/or the Fuel Tax Acts.Product to be Transported: (Check R applicable boxes.)

Gasoline ProductGasolineEthanol Blended GasolineDenatured Fuel EthanolAviation FuelPropane

Fuel ProductClear FuelColoured FuelKerosene

Mode of Product Transportation: Motor Vehicle

Marine Vessel

Railway Pipeline Otherplease specify

Are you registered as an Interjurisdictional Carrier (IJC)? Yes No

If Yes, enter your International Fuel Tax Agreement (IFTA) Registration No.

If No, to obtain an Application for International Fuel Tax Agreement (IFTA) Registration visit our website at ontario.ca/ifta or contact the ministry at 1 866 ONT-TAXS (1 866 668-8297) or 1 800 263-7776 Teletypewriter (TTY).

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17. Owner of Product Information - List importer(s) and/or exporter(s) that you will transport your product(s) for below:

Owner Name (Importer/Exporter) Street No. and Name City/Town Province/State Postal/Zip Code


18. Are you dealing in Bio-Diesel?If Yes, please state Bio-Diesel Blend . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes No

DayMonthYear19. Date business commenced under your ownership . . . . . . . . . . . . . . . . . . . . . .

20. Certification

I certify that I am an authorized signing officer and all information given in this application is true, correct and complete.

Note: The first application for registration must be signed by the owner, director or officer of the company.First and Last Name (please print) Title

Signature Year DayMonth

It is an offence to make, participate in, assent to or acquiesce in the making of a false or deceptive statement in an application, as required under the Fuel Tax Act or Regulations and the Gasoline Tax Act or Regulations.

The personal information provided by you on this form is collected under the authority of the Gasoline Tax Act R.S.O. 1990, c. G.5 as amended and the Fuel Tax Act R.S.O. 1990 c.F.35 as amended, and will be used in the administration of the Act. Questions about this collection may be directed to a Program Information Officer with the ministry at 1 866 ONT-TAXS (1 866 668-8297) or 1 800 263-7776 Teletypewriter (TTY).

application to register for manufacturer, wholesaler, … · wholesaler, dyer, importer, exporter...

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