33 King Street West
PO Box 625
Oshawa ON L1H 8E9
Effective for Purchases from March 2, 2015 to February 29, 2016
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
Fields marked (*) are mandatory fields.
Identification number *
Other - Specify
Telephone no. (including area code)
If yes, please provide signature
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.
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.
Supporting documents attached
Guide available at ontario.ca/finance on webpage 3062
Complete a separate summary and schedule for each type of loss.
Destroyed (e.g., by fire)
Loss (e.g., vehicle accident)
3446E (2019/01) © Queen’s Printer for Ontario, 2019
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