Gasoline and Related Products

Gasoline and Related Products Fuel and Carbon Tax Transaction Report - FTG-1 Imports From Out-of-Jurisdiction

SHOW TOTALS CARRIED FORWARD TO "FUEL AND CARBON TAX SUMMARY FORM - FTG-TAX" FTG-1 Rev. 08/2019

Province Period Ended (YYYY/MM/DD)Collector Name Federal Business Number

Imports from Out-of-Jurisdiction (FTG-1) Company Name Federal Business Number Gasoline Aviation

Gasoline Natural Gas Propane Butane Naphtha Other Taxable

Other Non-Taxable TOTAL

Alberta

British Columbia

Manitoba

New Brunswick

Newfoundland

Northwest Territories

Nova Scotia

Nunavut

Ontario

Prince Edward Island

Quebec

Saskatchewan

Yukon

(Specify Jurisdiction) Imports from outside Canada

TOTAL Imports from Out-of-Jurisdiction (FTG-1)

Gasoline and Related Products Fuel and Carbon Tax Transaction Report - FTG-2 Acquisitions within Jurisdiction from Licensed Collectors



Collector Names Federal Business Number Gasoline Aviation

Gasoline Natural Gas Propane Butane Naphtha Other Taxable Other Non-Taxable TOTAL

TOTAL Acquisitions within Jurisdiction (FTG-2)

Gasoline and Related Products Fuel and Carbon Tax Transaction Report - FTG-3 Exports Out-of-Jurisidiction



Exports Out-of-Jurisdiction (FTG-3) Company Name Federal Business Number Gasoline Aviation

Gasoline Natural Gas Propane Butane Naphtha Other Taxable

Other Non- TOTAL

Alberta

British Columbia

Manitoba

New Brunswick

Newfoundland


Nova Scotia

Nunavut

Ontario


Quebec

Saskatchewan

Yukon


TOTAL Exports Out-of-Jurisdiction (FTG-3)

Gasoline and Related Products Fuel and Carbon Tax Transaction Report - FTG-4 Dispositions within Jurisdiction to Licensed Collectors



Collector Names Federal Business Number Gasoline Aviation

Gasoline Natural Gas Propane Butane Naphtha Other Taxable Other Non-Taxable TOTAL

TOTAL Dispositions within Jurisdiction to Licensed Collectors (FTG-4)

Gasoline and Related Products Fuel and Carbon Tax Transaction Report - FTG-5 NT Fuel and Carbon Tax - Exempt Sales

FTG-5 Rev. 09/2019SHOW TOTALS CARRIED FORWARD TO "FUEL AND CARBON TAX SUMMARY FORM - FTG-TAX"


Exempt Sales Federal Business Number Gasoline Aviation Gasoline Natural Gas Propane Butane Naphtha Other Taxable Other Non-

Taxable TOTAL

GNWT

Federal

School/Municipality

Other

Public Utility

Heating Fuel

TOTAL Exempt Sales (FTG-5)

Gasoline and Related Products Fuel and Carbon Tax Transaction Report - FTG-6 NT Fuel Tax Only - Exempt Sales




Taxable TOTAL

GNWT

Federal

School/Municipality

Other

Public Utility

Heating Fuel


Gasoline and Related Products Fuel and Carbon Tax Transaction Report - FTG-7 NT Carbon Tax Only - Exempt Sales




Taxable TOTAL

GNWT

Federal

School/Municipality

Other

Public Utility

Heating Fuel POS Rebate


Diesel and Related Products Fuel and Carbon Tax Transaction Report - FTD-1 Imports from Out-of-Jurisidiction

SHOW TOTALS CARRIED FORWARD TO "FUEL AND CARBON TAX SUMMARY FORM - FTD-TAX" FTD-1 Rev. 08/2019


Imports from Out-of-Jurisdiction (FTD-1) Company NameFederal

Business Number

Diesel Heating Fuel

Marine Diesel Jet Fuel Kerosene Bunker Fuel Locomotive

FuelOther

Taxable

Other Non-

TaxableTOTAL

Alberta

British Columbia

Manitoba

New Brunswick

Newfoundland


Nova Scotia

Nunavut

Ontario


Quebec

Saskatchewan

Yukon


TOTAL Imports from Out-of-Jurisdiction (FTD-1)

Diesel and Related Products Fuel and Carbon Tax Transaction Report - FTD-2 Acquisitions within Jurisdiction from Licensed Collectors



Collector NamesFederal Business

Number Diesel Heating Fuel Marine Diesel Jet Fuel Kerosene Bunker Fuel Locomotive

FuelOther

TaxableOther Non-

Taxable TOTAL

TOTAL Acquisitions within Jurisdiction (FTD-2)

Diesel and Related Products Fuel and Carbon Tax Transaction Report - FTD-3 Exports Out-of-Jurisidiction



Exports Out-of-Jurisdiction (FTD-3) Company Name Federal Business Number Diesel Heating

FuelMarine Diesel Jet Fuel Kerosene Bunker Fuel Locomotive

FuelOther

TaxableOther Non-

Taxable TOTAL

Alberta

British Columbia

Manitoba

New Brunswick

Newfoundland


Nova Scotia

Nunavut

Ontario


Quebec

Saskatchewan

Yukon

(Specify Jurisdiction)Imports from outside Canada

TOTAL Exports Out-of-Jurisdiction (FTD-3)

Diesel and Related Products Fuel and Carbon Tax Transaction Report - FTD-4 Dispositions within Jurisdiction from Licensed Collectors



Collector NamesFederal Business


FuelOther

TaxableOther Non-

Taxable TOTAL

TOTAL Dispositions within Jurisdiction to Licensed Collectors (FTD-4)

Diesel and Related Products Fuel and Carbon Tax Transaction Report - FTD-5 NT Fuel and Carbon Tax - Exempt Sales



Exempt SalesFederal Business


Fuel Other Taxable Other Non-Taxable TOTAL

GNWT

Federal

School/Municipality

Other

Public Utility

Heating Fuel

TOTAL Exempt Sales (FTD-5)

Diesel and Related Products Fuel and Carbon Tax Transaction Report - FTD-6 NT Fuel Tax Only - Exempt Sales






GNWT

Federal

School/Municipality

Other

Public Utility

Heating Fuel


Diesel and Related Products Fuel and Carbon Tax Transaction Report - FTD-7 NT Carbon Tax Only - Exempt Sales






GNWT

Federal

School/Municipality

Other

Public Utility

Heating Fuel POS Rebate


Fuel and Carbon Tax Transaction Report - FTG-TAX Gasoline and Related Products

FTG-TAX Rev. 09/2019


Gasoline Aviation Gasoline Natural Gas Propane Butane Naphtha Other

TaxableOther Non-

Taxable TOTAL

1 Opening Untaxed Inventory 1

2 Refined or Manufactured within Jurisdiction 2

3 Imports from Out-of-Jurisdiction (FTG-1) 3

4 Acquisitions within Jurisdiction (FTG-2) 4

5 Rebrands 5

6 Subtract: Closing Untaxed Inventory 6

7 TOTAL ACCOUNTABLE VOLUMES 7

8 Subtract: Exports Out-of-Jurisdiction (FTG-3) 8

9 Subtract: Dispositions within Jurisdiction to Licensed Collectors (FTG-4) 9

10 Subtract: Exempt Sales (FTG-5) 10

11 Subtract: NT Fuel Tax Exempt Sales (FTG-6) 11

12 Subtract: Carbon Tax Exempt Sales (FTG-7) 12

13 Subtract: Volume Adjustments (Attach Details) 13

14 TOTAL VOLUMES SUBJECT TO NT FUEL TAX 14

15 TOTAL VOLUMES SUBJECT TO NT CARBON TAX 15

16 NT FUEL Tax Rate 16

17 NT CARBON Tax Rate 17

18 TOTAL TAX BEFORE ADJUSTMENTS 18

19 Adjustments and/or Tax Credits (Attach Schedules) 19

20 Deduct Shrinkage (Attach Schedules) 20

21 Deduct Commissions or Other Allowances (Attach Schedules) 21

22 NET TAX PAYABLE 22FOR OFFICE USE ONLY Other Adjustments or Installments (Provide Explanation) 23

TOTAL TAX PAYABLE (Gasoline) Carry forward to FTD-TAX 24

Fuel and Carbon Tax Transaction Report - FTD-TAX Diesel and Related Products

FTD-TAX Rev. 09/2019


Diesel Non-Motive

Heating Fuel

Marine Diesel Jet Fuel Kerosene Bunker Fuel Locomotive

FuelOther

TaxableOther Non-

Taxable TOTAL

1 Opening Untaxed Inventory 12 Refined or Manufactured within Jurisdiction 23 Imports from Out-of-Jurisdiction (FTD-1) 34 Acquisitions within Jurisdiction (FTD-2) 45 Rebrands 56 Subtract: Closing Untaxed Inventory 67 TOTAL ACCOUNTABLE VOLUMES 78 Subtract: Exports Out-of-Jurisdiction (FTD-3) 89 Subtract: Dispositions within Jurisdiction to Licensed Collectors (FTD-4) 9

10 Subtract: Exempt Sales (FTD-5) 1011 Subtract: NT Fuel Tax Exempt Sales (FTD-6) 11

12 Subtract: Carbon Tax Exempt Sales (FTD-7) 1213 Subtract: Volume Adjustments (Attach Details) 1314 TOTAL VOLUMES SUBJECT TO NT FUEL TAX 1415 TOTAL VOLUMES SUBJECT TO NT CARBON TAX 1516 NT FUEL Tax Rate 1617 NT CARBON Tax Rate 1718 TOTAL TAX BEFORE ADJUSTMENTS 18

19 Adjustments and/or Tax Credits (Attach Schedules) 19

20 Deduct Shrinkage (Attach Schedules) 20

21 Deduct Commissions or Other Allowances (Attach Schedules) 21

22 Deduct Large Emitter Rebate @ 72% (Attach Details) 22

23 NET TAX PAYABLE 23

E-Mail Address Fax No. Phone No. + Ext. Other Adjustments or Installments (Provide Explanation) 24

Name and Title Address TOTAL TAX PAYABLE (Diesel) 25

I certify that the statements indicated above are true and correct: TOTAL TAX PAYABLE (Gasoline) from FTG-TAX 26

Date Signed Signature TOTAL PAYMENT AMOUNT (Line 23 and Line 24) 27

Documents

Gasoline and Related Products