COVID-19 Energy Assistance Program (CEAP)

Instructions

Please complete an electricity application for your primary residence (where you reside for more than 6 months of the year). You cannot receive COVID-19 Energy Assistance Program (CEAP) funding for multiple residences. If you previously applied for and received CEAP funding, you may reapply for your primary residence once more. If you have natural gas service, you may apply separately for natural gas CEAP support through your natural gas utility.

After you have provided your information, please sign this form and provide your consent by: (a) if submitting electronically, typing your name(s) in Section 4; or (b) if submitting by mail, download and complete the PDF version of the application and sign Section 4 by hand. Please ensure that the information provided is accurate and up-to-date.

Once completed, the form can be submitted electronically by clicking the Submit button.

CEAP funding is limited and applying does not guarantee that your utility has CEAP funding remaining. Applications will be processed in the order they are received. For information on lower-income energy support programs available, please visit the Ontario Energy Board’s website

You are eligible for this program if,

As of the date you are applying, you have overdue amounts owing from one or more electricity bill(s) incurred since March 17, 2020, the date of the initial Provincial Declaration of Emergency.

If you previously received funding under this program and are reapplying based on overdue amounts still owing, you may qualify for additional funding up to a total combined maximum credit of $750.

If you are not eligible for CEAP, you may still be eligible for lower-income energy support programs. Please visit the Ontario Energy Board’s website for more information. You may also contact your utility for information on entering into an Arrears Payment Agreement.

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COVID-19 Energy Assistance Program (CEAP) Application Form (Electricity)

Section 1: Notice and Consent

When you submit this completed form to your utility, your utility is collecting your personal information in accordance with applicable privacy legislation such as the Municipal Freedom of Information and Protection of Privacy Act or the federal Personal Information Protection and Electronic Documents Act and the licence granted to it by the Ontario Energy Board under the Ontario Energy Board Act, 1998.

Your personal information is being collected for the purpose of administering CEAP, including but not limited to, determining your eligibility for CEAP.

In addition, your utility may use personal information already collected from you for the purposes of administering your utility account (e.g., any data respecting billing, and bill payments), for the purposes of evaluating your eligibility for CEAP and administering CEAP.

The funding for CEAP is provided by the Government of Ontario. Given that, in order to verify and determine whether you were eligible for CEAP and/or to otherwise administer CEAP, it may be necessary for your utility to share your information with the Ministry of Energy, Northern Development and Mines. If the Ministry of Energy, Northern Development and Mines requests any of the personal information contained in this form in order to verify your eligibility for CEAP or for audit purposes related to the administration of CEAP, your utility will supply it to them. The Ministry of Energy, Northern Development and Mines may contact you for further information as part of their audit. You are encouraged to retain any documentation that demonstrates you meet the eligibility for CEAP.

By completing and submitting this application form, you are consenting to the collection, use, and disclosure of your personal information as described above.

Contact information for the person who can answer questions about the collection of the information in this form is available on your utility’s website.

Section 2: Program Eligibility Requirements

1. As of the date you are applying, do you have overdue amounts owing from one or more electricity bill(s) incurred since March 17, 2020, the date of the initial Provincial Declaration of Emergency?

Yes: I have overdue amounts owing from one or more electricity bill(s) since March 17, 2020. ► If you select Yes, your electricity utility will verify this information.No: ► If you select No, CEAP is a targeted program designed to aid customers who have overdue amounts on their electricity bills as a result of the COVID-19 pandemic and the emergency that was declared in Ontario on March 17, 2020. The response you have selected means your household does not meet the program’s eligibility criteria.

2. Have you previously applied for and received funding under this program?

Yes: I previously applied and received funding under this program. ► If you select Yes, and are eligible, the total of previously received funding and any additional funding will not exceed the new maximum credit of $750.No: ► If you select No, you may be eligible to receive funding, up to the new maximum credit of $750.

Section 3: Utility Account Holder Information

Before you begin, make sure that you have a copy of your bill for reference.

Utility Account Information: Please enter your information exactly as it appears on your utility bill. If your information is not entered as it appears on your utility bill, your application may not be able to be processed until the information can be corrected and verified.

1. Your Utility

Your Utility

2. Utility Account Information

Utility Account Number

Account Holder's Full Name(s)

0 /

Account Holder's Service Address

0 /

3. Your Contact Information (please provide the best number or e-mail address for your utility to contact you if they have questions about your application):

Your Phone Number (home, work or mobile)

Your Email

Section 4: Declaration

By signing below,

a) I declare that the information I have provided in this application is true and correct; and

b) I indicate my consent to the collection, use and disclosure of my personal information as described in this form

Name of Account Holder

Date

Sign by hand or type your name

Your utility will review this application and notify you whether you are eligible for CEAP. If approved, a one-time credit amount will appear on your next bill or the following one, depending on where you are in the billing cycle. If you have any questions about this form, please email service@lakelandpower.on.ca or call 1-888-282-7711 Ext 213.