Form Fin 472 - Application For Refund Of Provincial Fuel Tax For Persons With Disabilities Page 2
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1
2
3
4Step 5 Fuel Purchase Information
• Claims must be submitted within six years from the date you purchased the fuel.
• Each receipt must show that fuel was purchased, date purchased, number of litres purchased, and seller’s name and address.
Fuel Type
Area of Fuel Purchases
✔
✔
(
)
(
)
Select
the one
Select
the one area
Fuel Litres
Refund Claim Periods
type of fuel that you
where you purchased
Enter the
• Put your receipts in date order
purchased the most of
most of your fuel from
number of litres
• Total the number of litres for
purchased
Greater
Greater
each refund claim period, as
Other
for each refund
Vancouver
Victoria
Gas
Diesel Propane
Areas
indicated below
claim period
(see listing
(see listing
of BC
below)
below)
January 1, 2006 to December 31, 2006
12 months – refund maximum $500
Litres
January 1, 2005 to December 31, 2005
12 months – refund maximum $500
Litres
January 1, 2004 to December 31, 2004
12 months – refund maximum $500
Litres
January 1, 2003 to December 31, 2003
12 months – refund maximum $400
Litres
August 1, 2002 to December 31, 2002
5 months – refund maximum $170
Litres
August 1, 2001 to July 31, 2002
12 months – refund maximum $400
Litres
August 1, 2000 to July 31, 2001
12 months – refund maximum $400
Litres
August 1, 1999 to July 31, 2000
12 months – refund maximum $400
Litres
Greater Vancouver Area:
Anmore, Belcarra, Bowen Island, Burnaby, Coquitlam, Delta, Electoral Area “A”, Langley, Lions Bay, Maple Ridge, New Westminster,
North Vancouver, Pitt Meadows, Port Coquitlam, Port Moody, Richmond, Surrey, Vancouver, West Vancouver, White Rock
Greater Victoria Area:
Central Saanich, Colwood, District of Sooke, Esquimalt, Langford, Langford Electoral Area, Metchosin, North Saanich, Oak Bay,
Saanich, Sidney, Victoria, View Royal
Freedom of Information and Protection of Privacy Act (FIPPA)
The personal information requested is collected under the authority of and used for the purpose of administering the Motor Fuel Tax Act . Questions
about how the FIPPA applies to this personal information can be directed to the general inquiry line at 604 660-4524 in Vancouver, or toll-free at
1 877 388-4440 elsewhere in Canada, or in writing to Revenue Programs Division, Suite 800 - 360 West Georgia Street, Vancouver BC V6B 6B2.
REFUND ID
TOTPD
PERIOD
FOR OFFICE USE ONLY
VERIFIER'S INITIALS
DATE
APPROVER'S INITIALS
YYYY
MM
DD
FIN 472/WEB (Page 2) Rev. 2005 / 11 / 1
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