2022 Nova Scotia - Annual filters promotion claim form

Annual filters promotion

For Nova Scotia Collection facilities
Filters - Claim form

From January 1st, 2022 to December 31st, 2022
For Atlantic Used Oil Management Association usage only

Invoice: ___________________________________

GL # ________________ Date: _______________

HST (15%) __________________

Sub-total: __________________
Total: ______________________

Prepared by ________________________________

Signature __________________________________
Make sure you have all the waybills left behind by your collector upon collection of your used FILTERS because you will be required to attach them to the following form.
Atlantic Used Oil Management Association (NS) #*
UOMA NS registration number
Collection facility name*
Company name
Address*

Street

Rue 2e ligne

CityProvince

Postal Code

Subtotal
HST@15%
GRAND TOTAL (Including taxes)
I, {personneContact}, {title}, confirm the information provided on this form is accurate and I recognize it could be subject to audits. The detailed files supporting this claim are available for consultation upon request. I certify that, from the best of my knowledge, the used products listed in the current claim were generated in Nova Scotia.
Signature*

Clear
Signature*

I confirm my signature.
Date*

DayMonthYear
Atlantic Used Oil Management Association (NS) HST # 830035432RT0004
Should be Empty:

Annual filters promotion