COVID-19 Energy Assistance Program (CEAP) Section 1: Notice and Consent When you submit this completed form to CARMA, we are 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, CARMA may use personal information already collected from you for the purposes of administering your 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 CARMA 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, CARMA 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 CARMA'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.No If you select Yes, If you select Yes, CARMA will verify this information. 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.No 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. If you select No, you may be eligible to receive funding, up to the new maximum credit of $750. Section 3: Account Holder Information Before you begin, make sure that you have a copy of your bill for reference. Account Information: Please enter your information exactly as it appears on your CARMA bill. If your information is not entered as it appears on your CARMA bill, your application may not be able to be processed until the information can be corrected and verified. Account Number: * Account Holder's Full Name:* Account Holder's Service Address:* Email Address:* Phone:* * Indicates a required field. Section 4: Declaration By populating the details below, I declare that the information I have provided in this application is true and correct; and I indicate my consent to the collection, use and disclosure of my personal information as described in this form Name of Account Holder:* Date:* Signature:* CARMA 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. * Indicates a required field.