Fuel Charge Exemption

Complete this form if your building or facility is eligible for a Federal Carbon Tax exemption as defined under the Government of Canada’s Greenhouse Gas Pollution Pricing Act.

Before You Begin

Complete the Canada Revenue Agency (CRA) Exemption Certificate and attach to this form. The CRA certificate is required to complete the application process.
Refer to your SaskEnergy bill to include your account number and the delivery service point ID with your submission.
If you have multiple buildings, you will be asked to provide information and supporting documentation for each property.

For more information on how to apply for an exemption, contact Billing Services at 1-306-777-9090 or by email.

Fuel Charge Exemption Form

Account Information

Account Information
SaskEnergy Account Number (11-digits) Delivery Service Point ID (10-digits) Service Address or Land Location Exemption Type Registered Distributor Include signed copy of CRA form L401 Registered User Include signed copy of CRA form L401-1 Registered Emitter Include signed copy of CRA form L401-1 Greenhouse Operator Include signed copy of CRA form L404

Attachments

Attach one copy of the CRA Exemption Certificate for each applicable exemption type (L401, L401-1, and/or L404)

Maximum 3 files.
10 MB limit.
Allowed types: GIF, JPG, JPEG, DOC, DOCX, BMP, PDF, PNG, PPT, PPTX, XLS, XLSX, VSD, DWG, DXR, DWF, TIF, TIFF.

Business and Contact Information

Legal Company Name

First Name

Last Name

Phone

Mailing Address

City/Town

Province/State

Postal/Zip Code

Acknowledgement

By selecting “I agree”, you

acknowledge and agree the information provided is accurate and complete;
are an authorized agent to make this request;
acknowledge and agree to the use, collection, storage and retention of your personal information, and any other information you provide with this form in accordance with our Privacy Policy and Terms & Conditions of Service Schedule, as applicable;
accept that it is your responsibility to notify SaskEnergy of any changes to the information provided.

I agree