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Government of Ontario: Ministry of Finance

33 King Street West
PO Box 625
Oshawa ON L1H 8E9

1-866-ONT-TAXS
1-866-668-8297

Application for Refund - Summary
Loss of Product (PRL) 2011/2012

Effective for Purchases from March 1, 2011 to February 29, 2012

Alcohol, Cannabis and Gaming Regulation and Public Protection Act, 1996

Guide available at ontario.ca/finance on webpage 3062: Guide for Completing the Application for Refund – Loss of Product (PRL) Summary and Schedule

Fields marked (*) are mandatory fields.

Product type *

Beer

Legal name * and address

Legal name
Address

Identification number *

A. Ownership information

Type of legal entity (check one)

Sole proprietorship Partnership Corporation Other Other - Specify

Name of Owners/Director

Last name
First name
Middle initial
Title
Telephone no. (including area code)

Address

Unit no.
Street no.
Street name
PO box
City/Town
Province/State
Postal/Zip code

Signing officer

Yes No
If yes, please provide signature

Summary	From	To	Refund claim amount ($) Total from attached schedule
B. Invoice dates	Invoice date - from Year Month Day	Invoice date - to Year Month Day	C. Refund claim amount ($), Totals from attached schedules

Certification

Please ensure that an authorized person signs the application. It is an offence to make a false statement in an application.
I certify that the information in this application is, to the best of my knowledge and belief, true, correct and complete.
I certify that tax and amounts on account of the tax under the Alcohol, Cannabis and Gaming Regulation and Public Protection Act, 1996, in respect of the product for which this refund is claimed have been remitted to the Minister or have been paid over to the person(s) from whom the product was purchased for remittance to the Minister. I certify that compensation for the loss is not available, has not been received, nor is compensation for the loss being sought, other than through this application.

Name
Title
Telephone
Signature
Date

Warning Penalties may be imposed if an applicant for a refund has misrepresented a material fact on or in connection with an application for refund or in an invoice supporting the application.
Charges may be laid and fines result, where a person obtains or attempts to obtain a refund by deceit, falsehood or any fraudulent means.

This application and any refund payment are subject to audit by the Ministry of Finance.

Ministry Use

Supporting documents attached Void cheque
Date Received

ORC Number

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Government of Ontario: Ministry of Finance

Application for Refund - Schedule
Loss of Product (PRL) 2011/2012

Effective for Purchases from March 1, 2011 to February 29, 2012

Alcohol, Cannabis and Gaming Regulation and Public Protection Act, 1996

Beer Schedule – Loss of Product

Identification number

Guide available at ontario.ca/finance on webpage 3062

Legal name

A. Loss of product

Date of loss:

Year Month Day

Type of loss (check one)

Complete a separate summary and schedule for each type of loss.
Stolen Destroyed (e.g., by fire) Loss (e.g., vehicle accident)

B. Refund calculation


Basic tax
Beer type	A. Total litres purchased per beer type	B. Total refundable litres per beer type	C. Ontario beer basic tax rate	D. Refund claim amount per beer type ($) D = (B × C)
Beer Manufacturer Draft	Beer Manufacturer Draft - A. Total litres purchased	Beer Manufacturer Draft - B. Total refundable litres	0.5568	Beer Manufacturer Draft - D. Refund claim amount D = (B × C) 1.
Beer Manufacturer Non-Draft	Beer Manufacturer Non-Draft - A. Total litres purchased	Beer Manufacturer Non-Draft - B. Total refundable litres	0.7094	Beer Manufacturer Non-Draft - D. Refund claim amount D = (B × C) 2.
Microbrewer Draft	Microbrewer Draft - A. Total litres purchased	Microbrewer Draft - B. Total refundable litres	0.1919	Microbrewer Draft - D. Refund claim amount D = (B × C) 3.
Microbrewer Non-Draft	Microbrewer Non-Draft - A. Total litres purchased	Microbrewer Non-Draft - B. Total refundable litres	0.2095	Microbrewer Non-Draft - D. Refund claim amount D = (B × C) 4.
Total	Total - A. Total litres purchased	Total - B. Total refundable litres	Refund claim amount ($) Box 1 + 2 + 3 + 4	Refund claim amount ($) Box 1 + 2 + 3 + 4 5.
Volume tax
Total refundable litres				Volume tax - Total refundable litres 6.
Ontario beer volume tax rate				7. 0.1760
Refund claim amount ($) Box 6 × 7				Volume tax - Refund claim amount ($) Box 6 × 7 8.
Environmental tax
Total number of non-refillable containers				Environmental tax - Total number of non-refillable containers 9.
Ontario environmental tax rate				10. 0.0893
Refund claim amount ($) Box 9 × 10				Environmental tax - Refund claim amount ($) Box 9 × 10 11.
Total refund claim amount ($) Box 5 + 8 + 11				Environmental tax - Total refund claim amount ($) Box 5 + 8 + 11 12. Include this amount in Box C in the Summary, page 1.

ORC Number

return to summary page

Government of Ontario: Ministry of Finance

Application for Refund - Summary Loss of Product (PRL) 2011/2012

A. Ownership information

Certification

Government of Ontario: Ministry of Finance

Application for Refund - Schedule Loss of Product (PRL) 2011/2012

Beer Schedule – Loss of Product

A. Loss of product

B. Refund calculation

Application for Refund - Summary
Loss of Product (PRL) 2011/2012

Application for Refund - Schedule
Loss of Product (PRL) 2011/2012