transportation services for persons with disabilities

Transportation Services for Persons with Disabilities and Seniors and Vehicle Retrofit Programs

Introduction Access to affordable, reliable and barrier free transportation is an issue that has been raised by individuals and stakeholders who represent persons with disabilities and seniors across the province. New Brunswick’s population is spread out over a large geographic area with more than 70% living in rural communities. This creates significant challenges in providing accessible and affordable public transportation as economies of scale are difficult to realize. Statistically, approximately 23% of persons with disabilities are represented in the labour market. At the same time, persons with disabilities are disproportionately represented amongst social assistance recipients, persons living on fixed incomes or whose annual income is below the poverty line. Yet the costs associated with permanent disabilities have been well documented as being extremely high. Thus, the option of private vehicle ownership is unattainable for most people with disabilities and/or seniors. Throughout New Brunswick, public transportation is available only in four municipalities: Fredericton, Miramichi, Moncton and Saint John. Unfortunately, at time of writing, only Saint John and Moncton provide any access to public transit. Thus, persons with disabilities unable to access fixed route/public transit must rely on parallel transit. These organizations are typically under resourced and require passengers to make reservations; often several days in advance. This directory, maintained by the Premier’s Council on the Status of Disabled Persons, lists both not-for-profit and commercial operators who provide accessible transportation. Although every effort is made to insure the accuracy of the information, readers are asked to contact the Premier’s Council if errors or omissions are encountered. Additionally, if there are organizations not included in this directory, please share this with the Council so that we can include them in subsequent publications. The Premier’s Council on the Status of Disabled Persons does not endorse or recommend the organizations included in this directory.

Transportation Services for Persons with Disabilities and Seniors and Vehicle Retrofit Programs Contents FEDERAL ASSISTANCE .......................................................................................... 1

CANADA REVENUE AGENCY ............................................................................. 1 Travel expenses ................................................................................................. 1 Specially Equipped Motor Vehicles ................................................................. 2 Federal Excise Gasoline Tax Refund Program ................................................ 4

CANADIAN TRANSPORTATION AGENCY ....................................................... 6 Accessible Transportation Directorate ............................................................ 6

DEPARTMENT OF FINANCE .............................................................................. 7 Parking placards for persons with a disability ................................................. 8

DEPARTMENT OF SOCIAL DEVELOPMENT ................................................... 9 DEPARTMENT OF TRANSPORTATION AND INFRASTRUCTURE ............... 18

Manufacturers’ Mobility Programs ........................................................................ 19 TRANSPORTATION SERVICES BY REGION ...................................................... 20

MARITIMES ...................................................................................................... 20 Maritime Bus .................................................................................................. 20

ACADIAN PENINSULA ...................................................................................... 21 Commission des Loisirs .................................................................................. 21 Les Résidences Inkerman Inc. ....................................................................... 22

BATHURST ........................................................................................................ 23 Bathurst Community Venture Van Inc. ......................................................... 23

CHARLOTTE COUNTY ..................................................................................... 24 Charlotte Dial-A-Ride .................................................................................... 24

DALHOUSIE ...................................................................................................... 25 Dalhousie Nursing Home ............................................................................... 25

FREDERICTON ................................................................................................. 26 Dial-A-Bus ....................................................................................................... 27

FREDERICTON JUNCTION ............................................................................. 28 White Rapids Manor Inc. ............................................................................... 28

MIRAMICHI ...................................................................................................... 29 Miramichi Accessible Transit ......................................................................... 29

MONCTON ......................................................................................................... 30 Ability Transit ................................................................................................. 30 Canadian Red Cross ........................................................................................ 31 The Wheelchair Guy ....................................................................................... 32


Wheels on Wheels .......................................................................................... 33 SAINT JOHN ..................................................................................................... 34

Canadian Red Cross ....................................................................................... 34 Handi-Bus....................................................................................................... 35 Saint John Transit Commission ..................................................................... 36

SUSSEX ............................................................................................................... 37 Kiwanis Nursing Home ................................................................................... 37

WOODSTOCK .................................................................................................... 38 Woodstock Community Transport Inc. ......................................................... 38

OTHER PROGRAMS ............................................................................................. 39 IRVING OIL ....................................................................................................... 39

Fuel the Care Program ................................................................................... 39 STAN CASSIDY CENTRE FOR REHABILITATION ......................................... 40 EASTER SEALS CANADA .................................................................................. 41

Disability Travel Card ...................................................................................... 41 FULL SERVICE GAS STATIONS .......................................................................... 42 Appendices .............................................................................................................. 51

Transportation Services for Persons with Disabilities and Seniors and P a g e | 1 Vehicle Retrofit Programs

FEDERAL ASSISTANCE

CANADA REVENUE AGENCY Website: www.cra-arc.gc.ca TRAVEL EXPENSES Website: www.cra-arc.gc.ca/tx/ndvdls/tpcs/ncm-tx/rtrn/cmpltng/ddctns/lns300-350/330/llwbltrvl-eng.html If you had to travel at least 40 kilometres (one way) from your home to obtain medical services, you may be able to claim the public transportation expenses you paid (for example, taxis, bus, or train) as medical expenses. Where public transportation is not readily available, you may be able to claim vehicle expenses. If you had to travel at least 80 kilometres (one way) from your home to obtain medical services, you may be able to claim accommodation, meal, and parking expenses in addition to your transportation expenses as medical expenses. To claim transportation and travel expenses, the following conditions must be met:

• substantially equivalent medical services were not available near your home;

• you took a reasonably direct travelling route; and • it is reasonable, under the circumstances, for you to have travelled to

that place for those medical services. If a medical practitioner certifies in writing that you were incapable of travelling alone to obtain medical services, you can also claim the transportation and travel expenses of an attendant who accompanied you. To determine if the treatment you received outside of Canada is an eligible medical expense, see Medical services provided outside of Canada.

Premier’s Council on the Status of Disabled Persons 2014


Meal and vehicle expenses You can choose to use the detailed method or the simplified method for calculating meal and vehicle expenses. If you use the detailed method, you have to keep all receipts and records for your 12-month period. For more information and to find out about the rates used to calculate these travel expenses, see Meal and vehicle rates used to calculate travel expenses for 2013. Accommodations You must keep receipts for all accommodation expenses and you must be able to show that the amount paid for accommodation is necessary because of the distance travelled and your medical condition. Claim the amount for accommodation as shown on your receipts. Medical services provided outside of Canada If you travel outside Canada to get medical services, you can claim the amounts you paid to a medical practitioner and a public or licensed private hospital. A "medical practitioner" is an individual (such as a doctor or a nurse) who is authorized to practice according to the laws of the jurisdiction that the services are provided in. A "licensed private hospital" is a hospital licensed by the jurisdiction that it operates in. SPECIALLY EQUIPPED MOTOR VEHICLES Web Site: www.cra-arc.gc.ca/tx/bsnss/tpcs/gst-tps/rbts/vhcls/menu-eng.html You can claim a specially-equipped motor vehicle rebate if you paid GST/HST on the purchase of a *qualifying motor vehicle, or you paid GST/HST on a **modification service performed on your motor vehicle.

Note For all expenses, you can only claim the part of the expense that you have not been and will not be reimbursed for. However, you can claim all of the expense if the reimbursement is included in your income (such as a benefit shown on a slip T4, Statement of Remuneration Paid) and you did not deduct the reimbursement anywhere else on your income tax and benefit return.


Transportation Services for Persons with Disabilities and Seniors and P a g e | 3 Vehicle Retrofit Programs To apply for the rebate, complete Form GST518, GST/HST Specially Equipped Motor Vehicle Rebate Application or see APPENDIX A.

* Qualifying motor vehicle A qualifying motor vehicle means a motor vehicle that is equipped with a device designed exclusively to assist in placing a wheelchair in the vehicle without having to collapse the wheelchair, or with an auxiliary driving control to facilitate the operation of the vehicle by an individual with a disability. Notes Before November 27, 2006, a motor vehicle would only qualify if it was new or had not been used since being specially equipped. This restriction has been removed for motor vehicles purchased after April 3, 1998. Beginning on November 27, 2006, you have four years to claim this rebate on a motor vehicle that was purchased after April 3, 1998, and did not previously qualify for this rebate.

**Modification service Modification service means a service (including parts) performed on a motor vehicle to specially equip or adapt the vehicle for its use by or in transporting an individual using a wheelchair, or to specially equip the vehicle with an auxiliary driving control to allow an individual with a disability to operate it. A rebate for modification services is only available where the modification services have been performed on a vehicle outside Canada or outside a participating province and brought back into Canada or into a participating province (subject to tax on the value added). Modification services performed within Canada or in a participating province are zero-rated.



FEDERAL EXCISE GASOLINE TAX REFUND PROGRAM Website: www.cra-arc.gc.ca/E/pbg/ef/xe8/ Telephone (bilingual): 1 (877) 432-5472

If you have a permanent mobility impairment, and cannot safely use public transportation, as certified by a qualified medical practitioner, you can apply for a refund of part of the federal excise tax on the gasoline you buy.

How the program works: You must be either:

• Registered Canadian amateur athletic association • Registered charity or • Individual with a permanent mobility impairment

The program allows you to claim a refund for part of the excise tax paid on gasoline at the rate of $0.015 per litre or $0.0015 per kilometre for allowances paid to employees for the operating expenses related to vehicles used for business purposes. To qualify for a refund, the gasoline you buy must be for your use and not for resale. Diesel fuel, heating fuel, propane, gasoline purchased in a foreign country, and aviation fuel do not qualify for an excise tax refund. Also, gasoline you buy for personal use does not qualify for a refund unless you are an individual with a permanent mobility impairment.

Before November 27, 2006, a rebate for a modification service performed outside Canada or outside a participating province and imported or brought back into Canada or into a participating province was not available if the vehicle was used by anyone except to the extent reasonably necessary to deliver it, to import it, or to bring it into NS, NB, or NL:

•after the modification service was performed; and •before the vehicle was imported into Canada or brought into NS, NB, or NL.

After November 26, 2006, this restriction has been removed and a vehicle purchased after April 3, 1998, that was used after modification would now qualify for this rebate.


Transportation Services for Persons with Disabilities and Seniors and P a g e | 5 Vehicle Retrofit Programs If your claim is less than $200, you can submit it for each six-month period ending June 30 or December 31. File your claim no later than one month after the end of the six-month period. For example, if you are claiming a refund of $150 for the period from January 1 to June 30, submit your claim by July 31. If your claim is $200 or more, you can submit it any time during the year. Please file a maximum of one claim per month. If your refund is for gasoline that you use in different vehicles, you should combine these amounts into one claim. Do not submit receipts or other documents with your application. However, you must keep your supporting documents such as invoices, receipts, or vouchers and confirmation-of-use statements, since we may ask you for proof that you purchased the gasoline for which you are claiming a refund. Your documents must contain enough information to allow us to verify your gasoline tax refund claim. Each proof of purchase must include the supplier's name, the purchase date, the quantity, and the price of gasoline purchased. We do not accept estimates for missing records. You can claim a refund for allowances that you paid your employees for the operating expenses related to the use of their personal vehicle for business purposes. You must keep copies of expense account statements that show kilometres and proof of payment to the employees. If you send receipts or vouchers to other government departments or agencies, you must keep copies or other written proof to support the application you file with us. You must keep all records and account books in Canada for six years from the end of the year to which they relate. If you are an organization or association, you must keep your books and records at your place of business in Canada.


Transportation Services for Persons with Disabilities and Seniors and P a g e | 6 Vehicle Retrofit Programs CANADIAN TRANSPORTATION AGENCY Website: www.otc-cta.gc.ca

Accessible Transportation Directorate Ottawa, ON K1A 0N9

Toll-free: (888) 222-2592 Toll-free TTY: (800) 669-5575

Fax: (819) 953-6019 Email: [email protected]

The Canadian Transportation Agency is an independent, quasi-judicial tribunal and economic regulator. It makes decisions and determinations on a wide range of matters involving air, rail and marine modes of transportation under the authority of Parliament, as set out in the Canada Transportation Act and other legislation. Their mandate includes:

• Economic regulation: to provide approvals, issue licences, permits and certificates of fitness, and make decisions on a wide range of matters involving federal air, rail and marine transportation.

• Dispute resolution: to resolve complaints about federal transportation services, rates, fees and charges.

• Accessibility: to ensure Canada's national transportation system is accessible to all persons, particularly those with disabilities.

The Agency also has a number of accessibility related information for download at www.otc-cta.gc.ca/eng/publications?f[0]=im_field_mode%3A1344.



PROVINCIAL ASSISTANCE DEPARTMENT OF FINANCE Website: www2.gnb.ca/content/gnb/en/departments/finance/taxes/vehicles_boats_aircraft.html Refund Section Revenue & Taxation Division PO Box 3000 Fredericton, NB E3B 5G5

Telephone: (800) 669-7070 Fax: (506) 457-7335

E-mail: [email protected]

8% PORTION OF THE HARMONIZED SALES TAX (HST) AND 13% PROVINCIAL VEHICLE TAX (PVT) OR 13% TANGIBLE PERSONAL PROPERTY TAX (TPPT) Upon the purchase of a motor vehicle in the Province of New Brunswick, the New Brunswick Government may refund the 8% provincial portion of the Harmonized Sales Tax (HST) or the 13% Provincial Vehicle Tax (PVT) on private sale transactions for persons with disabilities if:

• the motor vehicle is specially equipped with a device to enable a wheelchair or scooter to enter or leave the passenger vehicle (e.g. hydraulic lifts); or

• the motor vehicle is specially equipped with auxiliary driving controls that are used to facilitate the operation of the passenger vehicle (does not include spinner knobs); and

• the motor vehicle is not operated by any person for the purpose of earning a profit for any person or as part of any undertaking carried on for gain; and

• the claimant is not eligible for any other GST/HST credit or rebate related to this purchase.

Applications for refund of the 8% provincial portion of the Harmonized Sales Tax (HST) (form HST-R-02) can be obtained at any Service New Brunswick Centre or by contacting the Revenue & Taxation Division, Department of Finance at 1-800-669-7070. Along with the application the claimant must submit the following necessary supporting documents:

• copy of Bill of Sale and/or New Brunswick Tax Receipt;



• proof that the motor vehicle is specially equipped with a device to enable a wheelchair or scooter to enter or leave the passenger vehicle; or

• proof that the motor vehicle is fitted with auxiliary driving controls that are used to facilitate the operation of the passenger vehicle, truck, or van;

• a letter from a medical practitioner certifying that the person is disabled.

Provincial Vehicle Tax (PVT) or Harmonized Sales Tax forms can be obtained at any Service New Brunswick Centre or by contacting the Department of Finance. Copies of these forms are also found in APPENDIX C and APPENDIX D.

DEPARTMENT OF PUBLIC SAFETY PARKING PLACARDS FOR PERSONS WITH A DISABILITY The Province of New Brunswick issues Parking Placards and Permits for persons with disabilities to promote designated parking spaces for persons with disabilities. The intent of this program is to limit eligibility for the parking permit and placard for person(s) having a disability to those situations where the person has a significant degree of mobility impairment caused by paralysis, lower limb amputation, heart or lung disease or other health problems such that the person would have difficulty walking unassisted more than 50 metres in outdoor weather conditions. The placard and parking permit may be obtained upon application at Service New Brunswick Centres throughout the Province without charge. Application to obtain a parking permit and placard for designated parking spaces for persons with disabilities may be made at any Service New Brunswick Centre throughout the Province without charge. Applications must be signed by one of the following; a physician, occupation therapist, nurse practitioner or physiotherapist. The Motor Vehicle Act prohibits the

Any inquiry related to all other types of Harmonized Sales Tax (HST) refunds must be made to the Canada Revenue Agency at (800) 959-5525.


Transportation Services for Persons with Disabilities and Seniors and P a g e | 9 Vehicle Retrofit Programs use of designated parking spaces for persons with mobility impairments unless the appropriate identification is displayed inside the vehicle. A copy of the application form has been included in APPENDIX E. They can also be obtained by contacting Service New Brunswick at: Toll-free: (888) 762-8600 From outside New Brunswick: (506) 684-7901 Email: [email protected] Website: www.snb.ca DEPARTMENT OF SOCIAL DEVELOPMENT Moncton Richibucto

Sackville Shediac

1 (866) 426-5191

Saint John St. Stephen Sussex

Hampton St. George

1 (866) 441-4340

Fredericton Woodstock

Perth-Andover 1 (866) 444-8838

Edmundston Grand Falls 1 (866) 441-4249 Campbellton Kedgwick 1 (866) 441-4245 Bathurst 1 (866) 441-4341 Miramichi Neguac 1 (866) 441-4246 Caraquet Tracadie-Sheila

Lamèque Shippagan

1 (866) 441-4149

Transportation CDO Regular Employment Item Detail This special benefit may be available to assist clients who have a developed case plan and wish to access unsubsidized employment opportunities. This benefit may only be provided as a one issue benefit until receipt of first pay.


Transportation Services for Persons with Disabilities and Seniors and P a g e | 1 0 Vehicle Retrofit Programs The most economical method of transportation must be used at the following rates: Private Vehicle: 20 cents per km. The driver receives this rate only once, regardless of number of passengers. Bus: Actual cost of fare. Local: An allowance of $3 per day may be provided for those who live too far to walk, but not far enough to receive an applicable benefit. Required Documents:

• Confirmation from Employment and Social Development Canada as to whether a transportation allowance is being paid; and if so, the amount

• Confirmation from employer of days to be worked and days until first pay

• Case plan CDO Subsidized Employment Item Detail This special benefit may be available to assist clients who have a developed case plan and wish to access subsidized employment opportunities. This benefit may only be provided as a one issue benefit until receipt of first pay. The most economical method of transportation must be used at the following rates: Private Vehicle: 20 cents per km. The driver receives this rate only once, regardless of number of passengers Bus: Actual cost of fare Local: An allowance of $3 per day may be provided for those who live too far to walk, but not far enough to receive an applicable benefit. Required Documents:

• Confirmation from Employment and Social Development Canada as to whether a transportation allowance is being paid, and if so, the amount

• Written statement from employer confirming days worked • Case plan


Transportation Services for Persons with Disabilities and Seniors and P a g e | 1 1 Vehicle Retrofit Programs CDO Training Item Detail This special benefit may be available to assist clients who have a developed case plan and wish to access training opportunities. If the client is in receipt of transportation allowance from another agency such as SDC, payment may only be as a supplement if that rate is lower than what would be paid by SDC. The most economical method of transportation must be used at the following rates: Private Vehicle: 20 cents per km. The driver receives this rate only once, regardless of number of passengers. Bus: Actual cost of fare. Local: An allowance of $3 per day may be provided for those who live too far to walk, but not far enough to receive an applicable benefit. Required Documents:

• Confirmation from Employment and Skills Development Canada as to whether a transportation allowance is being paid and if so, amount.

• Invoice • Case plan

Work Services Item Detail - Obtaining and Retaining Obtaining: This special benefit may be available to Work Services clients, who have an Employability Assessment, a developed case plan and require transportation to Job Search. It may be provided as an ongoing benefit up to six months or until the client secures employment. Required documents:

• Case plan • Receipts for use of transportation allowance • Confirmation from Employment and Social Development Canada as

to whether a transportation allowance is being paid, and if so, the amount

• Verification of job search activities Retaining: This special benefit may be available to assist Work Services clients who have a developed case plan and have found employment. This benefit may only be provided as an ongoing benefit for one month from the start date of employment.


Transportation Services for Persons with Disabilities and Seniors and P a g e | 1 2 Vehicle Retrofit Programs Required documents:

• Confirmation from Employment and Social Development Canada as to whether a transportation allowance is being paid, and if so, the amount.

• Confirmation of the start date of employment • Case plan

Clients should not receive Transportation for Child Care and Transportation for seeking employment for the same distance travelled. Transportation for seeking employment would begin from the Child Care facility. The most economical method of transportation must be used at the following rates; Private Vehicle: 20 cents per km. The driver receives this rate only once, regardless of number of passengers. Bus: Actual cost of fare. Local: An allowance of $3 per day may be provided for those who live too far to walk, but not far enough to receive an applicable benefit. Taxi: Although the rate is 33 cents per km, the rate will appear as 38 cents when completing the Add a Benefit section. This takes the HST into account. The HST included check box should be selected when creating this benefit. The maximum monthly amount of this benefit is $100 per client. Work Services Item Detail - Obtaining Employment This special benefit may be available to Work Services clients (obtaining) who have a developed case plan and require transportation to access Daycare/Alternative Child Care or Child Care by paying transportation to the Child Care site. This benefit may only be provided as an ongoing benefit up to six months or until the client secures employment. The maximum monthly amount of this benefit is $100 per client.


Transportation Services for Persons with Disabilities and Seniors and P a g e | 1 3 Vehicle Retrofit Programs Required documents:

• Case plan • Receipts for use of transportation allowance • Clients should not receive Child Care Transportation and

transportation for seeking employment for the same distance travelled. Transportation for seeking employment would begin from the Child Care Facility.

Private - AHESS Item Detail This special benefit may be available to clients as per the criteria in the AHESS policy. Required Documents:

• Email from the AHESS worker giving details of approval • Invoice

Private -Family Support Order Services (FSOS) Item Detail This special benefit may be available to clients to pay for travel at 22 cents per km. for blood tests and/or court appearances. Payable upon proof of attendance at the hospital or court. Required Documents:

• Proof of appearance in court, or attendance at hospital for blood tests • Invoice

Private -Other Item Detail This special benefit may be available to women in transition and disaster victims to pay for transportation for reasons other than medical, training, or employment. This is paid at 22 cents upon receipt of invoice. An exception will be created when you issue this benefit to a single-person or multi-person case without children, where in either instance the case is not certified disabled. Required Documents:

• Confirmation from authorities that a disaster has occurred or • Confirmation from client or police authorities that abuse has taken

place and a note created on file • Invoice


Transportation Services for Persons with Disabilities and Seniors and P a g e | 1 4 Vehicle Retrofit Programs Taxi -AHESS Item Detail This special benefit may be available to clients as per the criteria in the AHESS policy. Required Documents:

• Email from the AHESS worker giving details of approval • Invoice

Taxi - Family Support Order Services (FSOS) Item Detail This special benefit may be available to clients to pay for travel for blood tests and/or court appearances. Within the city or town limits, the actual cost of the taxi fare is paid; otherwise it is paid at 33 cents per km. Paid as a one issue only, payable upon proof of attendance at the hospital or court. Required Documents:

• Proof of appearance in court, or attendance at hospital for blood tests • Invoice

Taxi - Medical Transportation Item Detail This special benefit may be available to clients who require transportation for medical reasons and who use taxi. May be paid:

• in emergency situations. • if frequent medical attention is required, creating financial hardship. • if medical service is not available within 25 km. • If service is available within 25 km, only to be paid outside area if:

• the client is referred outside region with documentation from the physician indicating why the client cannot obtain service in region.

• the client had surgery outside region and is returning for checkup. The most economical method of transportation must be paid if medical condition of the client will permit. Regardless of the number of clients in a vehicle, payment is only made for one. Payment is to a maximum of 43 cents per km (HST included) outside municipality. If within municipality where municipal taxi rates must be paid, choose Public Transportation.


Transportation Services for Persons with Disabilities and Seniors and P a g e | 1 5 Vehicle Retrofit Programs Required Documents:

• For ongoing - Medical Report, completed by the physician, stating diagnosis, transportation required, number of trips, and length of time needed.

• If going outside the area for services available within area, documentation as to why the client cannot obtain service in region.

• Proof that the appointment was kept. Taxi -Other Item Detail This special benefit may be available to women in transition and disaster victims to pay for transportation for reasons other than medical, training, or employment. This is paid upon receipt of invoice at 33 cents per km if outside city or town limits; and at the usual taxi rates if within the city or town limits. An exception will be created when you issue this benefit to a single-person or multi-person case without children, where in either instance the case is not certified disabled. Required Documents:

• Confirmation from authorities that a disaster has occurred or • Confirmation from client or police authorities that abuse has taken

place and a note created on file • Invoice

Treatment Program Transportation - private vehicle This special benefit may be available to clients who require daily transportation to a pharmacy or clinic in order to receive a prescribed medication within a treatment program (i.e., Methadone Program) and who travel by private vehicle, whether their own or another's. When the vehicle being used is not the client's, the special benefit is still paid to the client as opposed to the owner of the vehicle. Treatment Program Transportation Guidelines include:

• Daily transportation benefits will be offered to clients for a maximum total of 18 months.

• A maximum of $200 per month may be issued for this benefit. • The most economical means of available transportation must be used.


Transportation Services for Persons with Disabilities and Seniors and P a g e | 1 6 Vehicle Retrofit Programs

• This benefit may only be provided if the dispensing pharmacy or clinic is greater than 2.4 kilometres from the client's residence.

• If monthly bus passes are being issued for the daily transportation, no extra coverage is to be issued.

• Daily transportation benefits will be calculated based on the distance to the dispensing pharmacy that is closest to the client's place of residence.

Guidelines to these payments:

• Payment is limited to 20 cents per km for all vehicles. • Regardless of the number of clients in a vehicle, payment is only

made for one. Required documents:

• Proof of daily attendance from the pharmacy or clinic every month. Treatment Program Transportation - public transportation This special benefit may be available to clients who require daily transportation to a pharmacy or clinic in order to receive a prescribed medication within a treatment program (i.e., Methadone Program) and who use public transportation. NOTE: This special benefit may also be selected to pay the Treatment Program Transportation - Taxi benefit within a municipality according to the criteria for that benefit. This is necessary as the regular taxi rate may not be based on a per km amount. Treatment Program Transportation Guidelines include:

• Daily transportation benefits will be offered to clients for a maximum of 18 months.

• A maximum of $200 per month may be issued for this benefit. • The most economical means of available transportation must be used. • This benefit may only be provided if the dispensing pharmacy or

clinic is greater than 2.4 kilometres from the client's residence. • If monthly bus passes are being issued for the daily transportation, no

extra coverage is to be issued. Daily transportation benefits will be calculated based on the distance to the dispensing pharmacy that is closest to the client's place of residence.


Transportation Services for Persons with Disabilities and Seniors and P a g e | 1 7 Vehicle Retrofit Programs Guidelines to these payments:

• Bus: cover cost of fare. Required documents:

• Proof of daily attendance from the pharmacy or clinic every month. Treatment Program Transportation - taxi This special benefit may be available to clients who require daily transportation to a pharmacy or clinic in order to receive a prescribed medication within a treatment program (i.e., Methadone Program) and who use public transportation. Treatment Program Transportation Guidelines include:

• Daily transportation benefits will be offered to clients for a maximum of 18 months.

• A maximum of $200 per month may be issued for this benefit. • The most economical means of available transportation must be used. • This benefit may only be provided if the dispensing pharmacy or

clinic is greater than 2.4 kilometres from the client's residence. • If monthly bus passes are being issued for the daily transportation, no

extra coverage is to be issued. Daily transportation benefits will be calculated based on the distance to the dispensing pharmacy that is closest to the client's place of residence. Guidelines to these payments: Payment is to a maximum of 33 cents per km outside a municipality. If within a municipality where municipal taxi rates must be paid, choose Public Transportation. Regardless of the number of clients in a vehicle, payment is only made for one. Required documents:

• Proof of daily attendance from the pharmacy or clinic every month. Food & Shelter (Medical Transportation Item Detail) This special benefit may be available to all clients who require food and shelter when making medical trips outside the region or province. The standard rate is $ 7 per meal up to a maximum of $21 per day per person, unless meals are provided by hospital. Where daily rates established by


Transportation Services for Persons with Disabilities and Seniors and P a g e | 1 8 Vehicle Retrofit Programs service providers (i.e., IWK) are higher, the service provider’s rate would be covered. If the client is staying in a housekeeping unit, the standard rate will be $8 per day per person for groceries instead of a meal allowance. Provision can be made for meals, at the same rate, for a person required to accompany the client and also for lodging (usually at a hostel) for the person accompanying the client. Required Documents:

• Written confirmation from the physician, stating diagnosis, transportation required, length of time needed

• For accompaniment - a letter from the physician stating client cannot travel alone for medical reasons

• Verbal confirmation from the supplier of accommodations including estimate of cost, followed up by invoice for payment

• Proof that the appointment was kept DEPARTMENT OF TRANSPORTATION AND INFRASTRUCTURE Website: www2.gnb.ca/content/gnb/en/departments/dti/services/services_renderer.7715.Vehicle_Retrofit_Program_(Persons_with_Disabilities).html Vehicle Retrofit Program Department of Transportation and Infrastructure PO Box 6000 Fredericton, NB E3B 5H1

Telephone : (506) 453-5676 Fax : (506) 444-5207

E-mail : [email protected]

VEHICLE RETROFIT PROGRAM (PERSONS WITH DISABILITIES) This program is designed to increase the mobility of persons with a disability residing in the province of New Brunswick by providing financial assistance towards the cost of supplying and installing eligible retrofitting and accessibility features for vehicles. Eligible applicants include individual residents, organizations, municipalities or private companies providing transportation services to persons with a disability, all of which must reside or be based within the province of New Brunswick. Some examples of features eligible for assistance under the program include the following:

• Wheelchair/scooter lifts and ramps



• roof, floor and door alterations (if part of an accessibility retrofit) • special needs seating • hand controls • wheelchair tie downs and occupant restraint systems

Consideration may be given to other features not listed above. The New Brunswick Department of Transportation and Infrastructure’s Vehicle Retrofit Program is designed for access to transportation to increase the mobility of persons with a disability that are residents within the province by financially assisting in the retrofitting of vehicles. The following terms and conditions apply:

• 80% of the cost of eligible accessibility features for a new or existing vehicle to a maximum total grant of $8,000.00.

• Taxes are the responsibility of the applicant. • Sales tax on some accessibility features may be rebated by the

Department of Finance, Province of New Brunswick. • Renewable every 8 years for individuals, 5 years for organizations.

Note: The grant must be used within 6 months from the date on the letter of approval. It is the responsibility of the applicant to request an additional 6 month extension if required; otherwise, the grant will expire and a new application will be required. To be eligible for a grant the vehicle must have a valid Safety Inspection Sticker. The Department may require an inspection prior to approval of a grant. Consideration may be given to other features not listed above. A copy of the application form is available in APPENDIX F. MANUFACTURERS’ MOBILITY PROGRAMS Most manufacturers offer special rebate programs to assist in defraying the costs of adapting a vehicle for a person (driver and/or passenger) with disabilities. Speak with a representative of your dealership for more information about such programs and to apply.



TRANSPORTATION SERVICES BY REGION MARITIMES MARITIME BUS Customer Service Call Center (800) 575-1807 GEOGRAPHIC AREA SERVED: Maritime Provinces MODE OF TRANSPORTATION: Accessible coach equipped with a wheelchair lift HOURS OF OPERATION: See company’s posted schedule at www.maritimebus.com for details DESCRIPTION OF SERVICES PROVIDED: Offers a coach equipped with a lift and adapted to accommodate passengers who use wheelchairs. RESTRICTIONS AND/OR REQUIREMENTS FOR USE: The customer is asked to book 72 hours in advance by calling the Customer Service department to ensure that the vehicle is where it needs to be on the requested date of travel. If the bus is being used on the requested date then Maritime Bus will find an alternative means for transportation. USER FEES: See company’s posted fares at www.maritimebus.com for details.


Transportation Services for Persons with Disabilities and Seniors and P a g e | 2 1 Vehicle Retrofit Programs ACADIAN PENINSULA COMMISSION DES LOISIRS 28 de l'Hôpital Street PO Box 2037 Lamèque, NB E8T 3N4

Telephone: (506) 344-3222 Fax: (506) 344-3266

GEOGRAPHIC AREA SERVED: Acadian Peninsula. MODE OF TRANSPORTATION: 18-passenger wheelchair accessible van. HOURS OF OPERATION: Van is available 24 hours per day, 7 days per week. Keys must be picked up during office hours from Monday to Friday: 8:30 AM to 4:30 PM. DESCRIPTION OF SERVICES PROVIDED: 18-passenger wheelchair accessible van with a lift. Seats can be reconfigured to tie down a wheelchair. RESTRICTIONS AND/OR REQUIREMENTS FOR USE: Must have a qualified driver. Call the Centre d'activité La Ruche at 344-7793 (ask for Line) to reserve. USER FEES: $0.90 per kilometre.


Transportation Services for Persons with Disabilities and Seniors and P a g e | 2 2 Vehicle Retrofit Programs LES RÉSIDENCES INKERMAN INC. 1171 Pallot Road Inkerman, NB E8P 1C2

Telephone: (506) 336-3909 Fax: (506) 336-3912

Email: [email protected] GEOGRAPHIC AREA SERVED: Acadian peninsula. MODE OF TRANSPORTATION: Wheelchair accessible van. HOURS OF OPERATION: Monday to Friday: 8:00 AM to 5:00 PM. DESCRIPTION OF SERVICES PROVIDED: Wheelchair accessible van with lift that can accommodate two (2) wheelchairs. RESTRICTIONS AND/OR REQUIREMENTS FOR USE: Reservations must be made at least 48 hours in advance. USER FEES: $100 per day, plus fuel, plus $0.39 per kilometre.


Transportation Services for Persons with Disabilities and Seniors and P a g e | 2 3 Vehicle Retrofit Programs BATHURST BATHURST COMMUNITY VENTURE VAN INC. 23 Champlain Boulevard North Tetagouche, NB E2A 4Y8

Telephone: (506) 548-8644

GEOGRAPHIC AREA SERVED: Bathurst and surrounding areas. MODE OF TRANSPORTATION: 12-passenger mini-bus with wheelchair lift. HOURS OF OPERATION: Monday to Friday from 8:00 AM to 5:00 PM. Special arrangements can be made for evenings, weekends and holidays with advance notice. DESCRIPTION OF SERVICES PROVIDED: Van is equipped to seat eight (8) passengers and four (4) wheelchairs. RESTRICTIONS AND/OR REQUIREMENTS FOR USE: Clients must register with the driver coordinator a couple of days in advance. USER FEES: $0.73 per kilometre plus a $1 deductibility fee, up to $5 maximum per month.


Transportation Services for Persons with Disabilities and Seniors and P a g e | 2 4 Vehicle Retrofit Programs CHARLOTTE COUNTY CHARLOTTE DIAL-A-RIDE Website: www.charlottedial-a-ride.com PO Box 172 St. Stephen, NB E3L 2X1

Telephone: (506) 466-4444 Fax: (506) 466-0779

Email: [email protected] GEOGRAPHIC AREA SERVED: Charlotte County MODE OF TRANSPORTATION: Volunteer drivers. HOURS OF OPERATION: Monday to Friday from 9:00 AM to 5:00 PM. DESCRIPTION OF SERVICES PROVIDED: To provide access to transportation to those with little or no access due to geographic isolation, lack of accessible transport or affordability. RESTRICTIONS AND/OR REQUIREMENTS FOR USE: Members may be referred from agencies or self-referred to register with us. They must reserve at least 48 hours in advance. USER FEES: Minimum charge depending on distance.


Transportation Services for Persons with Disabilities and Seniors and P a g e | 2 5 Vehicle Retrofit Programs DALHOUSIE DALHOUSIE NURSING HOME 1 - 296 Victoria Street Dalhousie, NB E8C 2R8

Telephone: (506) 684-7816 Fax: (506) 684-7832

GEOGRAPHIC AREA SERVED: Dalhousie and surrounding areas. MODE OF TRANSPORTATION: Bus with a wheelchair lift. HOURS OF OPERATION: Monday to Friday: 8:00 AM to 4:00 PM. DESCRIPTION OF SERVICES PROVIDED: Bus with a wheelchair lift. RESTRICTIONS AND/OR REQUIREMENTS FOR USE: The public must reserve in advance, and a driver from the nursing home must be available. USER FEES: Varies depending on the destination. No fees within city limits.


Transportation Services for Persons with Disabilities and Seniors and P a g e | 2 6 Vehicle Retrofit Programs FREDERICTON CANADIAN RED CROSS Website: www.redcross.ca 318 Maple Street Fredericton, NB E3A 3R4

Telephone: (506) 458-8445 Fax: (506) 454-7522

GEOGRAPHIC AREA SERVED: Fredericton city limits. MODE OF TRANSPORTATION: Volunteers who use their own vehicle. HOURS OF OPERATION: Monday - Friday: 9:00 AM to 4:30 PM depending on volunteer availability. DESCRIPTION OF SERVICES PROVIDED: A transportation service of "last resort" providing assistance to those requiring someone to remain with them. RESTRICTIONS AND/OR REQUIREMENTS FOR USE: A referral service based on age and the necessity of having someone to accompany the user. Essential appointments only such as medical, banking, lawyer, etc. USER FEES: None


Transportation Services for Persons with Disabilities and Seniors and P a g e | 2 7 Vehicle Retrofit Programs DIAL-A-BUS Website: www.fredericton.ca/en/transportation/DialABus.asp PO Box 130 Fredericton, NB E3B 4Y7

Telephone: (506) 460-2212 Fax: (506) 460-2211

Email: [email protected] GEOGRAPHIC AREA SERVED: Fredericton city limits. MODE OF TRANSPORTATION: Accessible "Cutaway" style bus. HOURS OF OPERATION: Monday - Friday: 7:00 AM to 11:00 PM. Saturday: 10:00 AM to 5:00 PM and 7:15 PM to 11:00 PM DESCRIPTION OF SERVICES PROVIDED: Wheelchair accessible service to registered users. Dial-a-Bus also has a service available to scooter mobility aid users. A scooter lift has been installed on a minivan operated by our taxi contractor. RESTRICTIONS AND/OR REQUIREMENTS FOR USE: Users must be registered. Registration is through Easter Seals New Brunswick at (506) 458-8739. USER FEES: One-way fares are $3. Attendants, where required, travel at no cost.


Transportation Services for Persons with Disabilities and Seniors and P a g e | 2 8 Vehicle Retrofit Programs FREDERICTON JUNCTION WHITE RAPIDS MANOR INC. Website: www.whiterapidsmanor.nb.ca 233 Sunbury Drive Fredericton Junction, NB E5L 1S1

Telephone: (506) 368-6508 Fax: (506) 368-6512

Email: [email protected] GEOGRAPHIC AREA SERVED: Fredericton Junction and surrounding areas. MODE OF TRANSPORTATION: Bus with wheelchair lift. HOURS OF OPERATION: The bus is available upon request Monday - Sunday from 8:00 AM to 6:00 PM depending upon the availability of volunteer drivers and the needs of White Rapids Manor. DESCRIPTION OF SERVICES PROVIDED: One wheelchair accessible bus which can accommodate three (3) wheelchairs and ten (10) seated passengers or seats can be removed to accommodate more wheelchairs as required. RESTRICTIONS AND/OR REQUIREMENTS FOR USE: The public must request the bus in writing a minimum of 7 days prior to time required. The bus must be returned in good condition, i.e, clean and tidy. Only those drivers listed on the insurance policy can drive the bus. USER FEES: There is no user fee, however, the bus must be returned with a full tank of gas. All donations are greatly appreciated.


Transportation Services for Persons with Disabilities and Seniors and P a g e | 2 9 Vehicle Retrofit Programs MIRAMICHI MIRAMICHI ACCESSIBLE TRANSIT 80 University Avenue Box 1058 Miramichi, NB E1N 3W4

Telephone: (506) 773-9437

GEOGRAPHIC AREA SERVED: Miramichi and surrounding areas within 10 to 12 miles. Clients requiring transportation to other communities for medical reasons or preplanned social functions may make arrangements at least 24 hours in advance. MODE OF TRANSPORTATION: One wheelchair accessible bus, one wheelchair accessible van and one standard van for clients with higher mobility. HOURS OF OPERATION: Monday to Friday: 8:00 AM to 4:00 PM DESCRIPTION OF SERVICES PROVIDED: An accessible bus which can accommodate six (6) seated passengers and three (3) wheelchairs. The van can accommodate one client using a wheelchair. RESTRICTIONS AND/OR REQUIREMENTS FOR USE: Clients must give at least 24 hours’ advance notice. USER FEES: $7.00 within city limits to 12 miles. Call for information regarding charters.


Transportation Services for Persons with Disabilities and Seniors and P a g e | 3 0 Vehicle Retrofit Programs MONCTON ABILITY TRANSIT 115 - 236 St. George Street Moncton, NB E1C 1W1

Telephone: (506) 853-3055 Email: [email protected]

GEOGRAPHIC AREA SERVED: Moncton MODE OF TRANSPORTATION: Wheelchair accessible bus. HOURS OF OPERATION:

• Monday, Tuesday and Thursday: 7:00 AM to 5:00 PM. • Wednesday:7:00 AM to 10:00 PM. • Friday: 7:00 AM to 11:30 PM • Saturday: 11:00 AM to 7:00 PM.

DESCRIPTION OF SERVICES PROVIDED: Three (3) busses each equipped with hydraulic lifts and tie-downs for five (5) wheelchairs and room for four (4) seated passengers. RESTRICTIONS AND/OR REQUIREMENTS FOR USE: Persons with severe mobility problems. Call as early as possible. USER FEES: $2.25 per one-way trip or book of ten (10) tickets for $20.


Transportation Services for Persons with Disabilities and Seniors and P a g e | 3 1 Vehicle Retrofit Programs CANADIAN RED CROSS Website: www.redcross.ca 246 Lutz Street Moncton, NB E1C 5G3

Telephone: (506) 863-2650 Ext. 2655 Fax: (506) 863-2662

GEOGRAPHIC AREA SERVED: Moncton and Surrounding Areas. MODE OF TRANSPORTATION: Car HOURS OF OPERATION: Monday to Friday: 8:30 AM to 4:30 PM. DESCRIPTION OF SERVICES PROVIDED: Seniors 65+ for medical appointments depending on availability of volunteers. RESTRICTIONS AND/OR REQUIREMENTS FOR USE: Clients must be registered and mobile. They must reserve 72 hours in advance. USER FEES: None


Transportation Services for Persons with Disabilities and Seniors and P a g e | 3 2 Vehicle Retrofit Programs THE WHEELCHAIR GUY Telephone: (506) 384-4640 E-mail: [email protected] GEOGRAPHIC AREA SERVED: Moncton and surrounding areas. MODE OF TRANSPORTATION: Wheelchair accessible taxis HOURS OF OPERATION: Monday - Sunday: 6:00 am-9:00 pm Sunday: With 48 hours’ notice DESCRIPTION OF SERVICES PROVIDED: Five wheelchair-accessible vans with tie-downs. RESTRICTIONS AND/OR REQUIREMENTS FOR USE: Not applicable. USER FEES: Please call for rates.


Transportation Services for Persons with Disabilities and Seniors and P a g e | 3 3 Vehicle Retrofit Programs WHEELS ON WHEELS PO Box 1302 Moncton, NB E1C 8T6

Telephone: (506) 384-0969 Toll-free: (866) 856-0969

GEOGRAPHIC AREA SERVED: Moncton and surrounding areas, New Brunswick and Maritime provinces. MODE OF TRANSPORTATION: 7 minivans with lowered floors. HOURS OF OPERATION: Monday to Sunday from 7:00 am to 9:00 pm DESCRIPTION OF SERVICES PROVIDED: Van with ramp and lowered floor. Attendant service available upon prior notification. RESTRICTIONS AND/OR REQUIREMENTS FOR USE: Client must book ahead for out-of-town trips. USER FEES: Please call for fares.


Transportation Services for Persons with Disabilities and Seniors and P a g e | 3 4 Vehicle Retrofit Programs SAINT JOHN CANADIAN RED CROSS Website: www.redcross.ca 70 Lansdowne Avenue PO Box 39 Saint John, NB E2L 3X3

Telephone: (506) 674-6188 Fax: (506) 674-6129

GEOGRAPHIC AREA SERVED: Saint John and surrounding areas. MODE OF TRANSPORTATION: Volunteer drivers. HOURS OF OPERATION: Monday to Friday: 8:30 AM to 4:30 PM. DESCRIPTION OF SERVICES PROVIDED: Volunteer drive for seniors to needed medical appointments or to obtain groceries. RESTRICTIONS AND/OR REQUIREMENTS FOR USE: Availability of drives is based on volunteer resources. USER FEES: Free or with donation to Canadian Red Cross.


Transportation Services for Persons with Disabilities and Seniors and P a g e | 3 5 Vehicle Retrofit Programs HANDI-BUS 115 - 66 Waterloo Street Saint John, NB E2L 3P4

Telephone: (506) 643-7004 Fax: (506) 643-7009

GEOGRAPHIC AREA SERVED: Saint John MODE OF TRANSPORTATION: Wheelchair accessible vans. HOURS OF OPERATION:

• Mondays, Wednesdays and Fridays: 7:00 AM to 6:00 PM. • Tuesdays and Thursdays: 7:00 AM to 9:00 PM. • Saturdays: 11:00 AM to 6:00 PM, • Extended hours upon request for special events. • Services will be available for all Seadog games.

Additional service available at charter rates. Office hours from 8:00 AM to 3:00 PM, Monday to Thursday and 8:00 AM to 12:00 PM on Friday. Messages left after hours during the week will be picked up the next business day. DESCRIPTION OF SERVICES PROVIDED: An accessible transit system serving persons with mobility limitations or special needs, and seniors unable to utilize regular public transit system. RESTRICTIONS AND/OR REQUIREMENTS FOR USE: This service is available in the area served by the Saint John Transit Commission (unless on charter) and is for the use of Saint John residents only. USER FEES: Individual one-way cash trips within city limits - $5 Other fares dependent on destination Charter fares $50 per hour Monthly passes available - $75 for twenty trips or $40 for ten trips. There is no charge for attendant(s) or companion(s)


Transportation Services for Persons with Disabilities and Seniors and P a g e | 3 6 Vehicle Retrofit Programs SAINT JOHN TRANSIT COMMISSION Website: www.saintjohn.ca/en/home/cityhall/transportation/transit/default.aspx 55 McDonald Street Saint John, NB E2J 0C7

Telephone: (506) 658-4700 Fax: (506) 658-4704

Email: [email protected]

GEOGRAPHIC AREA SERVED: Saint John and surrounding area. MODE OF TRANSPORTATION: Low-floor busses equipped with ramps and wheelchair tie-downs HOURS OF OPERATION: 7days/week with restricted service on Sunday and holidays. See schedule for complete details DESCRIPTION OF SERVICES PROVIDED: Saint John Transit’s low-entry buses have the ability to drop to the curb and extend a ramp. Low-entry buses are wheelchair accessible and allow our passengers to board buses without climbing any steps. For planning purposes passengers can check to see if the route they will be traveling will use a low entry bus. USER FEES: Cash fares as of January 1, 2011 Adult (age 15 and over) $2.75 Senior Citizen (65 and over) $2.50 Child (age 6 to 14) $2.50 Child (age 5 and under) First 3 children free* *Children under the age of five (5) must be accompanied by an adult. Three children, age 5 or under may travel, with an adult, free of charge. For each additional child five (5) and under, fare is $2.50 each. Transcard: Adult 20 rides: $45.00 10 rides: $23.00 Students/Seniors (65 or older) 20 rides: $40.00 10 rides: $20.00


Transportation Services for Persons with Disabilities and Seniors and P a g e | 3 7 Vehicle Retrofit Programs SUSSEX KIWANIS NURSING HOME 11 Bryant Drive Sussex, NB E4E 2P3

Telephone: (506) 432-3118 Fax: (506) 432-3104

Email: [email protected] GEOGRAPHIC AREA SERVED: Sussex and surrounding areas. MODE OF TRANSPORTATION: Wheelchair van. HOURS OF OPERATION: Any time. Residents’ needs take priority. DESCRIPTION OF SERVICES PROVIDED: Wheelchair van and driver (if required). Will hold three (3) wheelchairs and four (4) seated passengers. RESTRICTIONS AND/OR REQUIREMENTS FOR USE: Drivers must be put on the nursing home's insurance and take a one-hour training course. Reservations are made through the business office of the nursing home. USER FEES: Gas tank must be filled prior to the return of the van. In addition, donations (tax receipts issued) are appreciated but not required.


Transportation Services for Persons with Disabilities and Seniors and P a g e | 3 8 Vehicle Retrofit Programs WOODSTOCK WOODSTOCK COMMUNITY TRANSPORT INC. c/o Canadian Red Cross 10 – 110 Richmond Street Woodstock, NB E7M 2N9

Telephone: (506) 328-8881 Fax: (506) 328-3180

Email: [email protected] GEOGRAPHIC AREA SERVED: Woodstock and surrounding areas. MODE OF TRANSPORTATION: Wheelchair accessible van. HOURS OF OPERATION: Van is available by reservation seven (7) days per week. Keys must be picked up at local Red Cross office from Monday to Friday between 8:30 AM and 4:30 PM. DESCRIPTION OF SERVICES PROVIDED: Large van seating sixteen (16) passengers or four (4) wheelchairs or a combination of the two. RESTRICTIONS AND/OR REQUIREMENTS FOR USE: The van is available for all members of the community. The driver must have a qualified driver with a Class-4 license, a criminal record check and instruction in using the wheelchair tie-downs and lift if they are to be used. The van is available to all members of the community subject to the priority of scheduling by designated user groups and other persons with limited transportation options. USER FEES: $20 plus $0.50 per km for trips over 30 kms. Van must be returned with a full tank of diesel.



OTHER PROGRAMS IRVING OIL FUEL THE CARE PROGRAM Irving Oil’s Fuel the Care program helps families across Atlantic Canada and New England with the cost of travel between home and hospital. Traveling to hospitals can be costly, so our program provides fuel gift cards to parents who must frequently travel to provide their children with urgent medical care. If your child is a patient at one of these healthcare systems, and you would like more information about the Fuel the Care program, please contact: New Brunswick: Saint John Regional Hospital Telephone: (506) 648-7369 Website: www.foundationhealthcarepartnership.ca Nova Scotia The IWK Health Centre Telephone: (902) 470-8076 Website: www.iwk.nshealth.ca Newfoundland & Labrador: Janeway Child Health and Rehabilitation Centre Telephone: (709) 777-4452 Website: www.janewayfoundation.nf.ca Maine: EMHS Contact your case worker at the EMHS hospital where your child is receiving services. Website: www.emh.org New Hampshire: The Children's Hospital at Dartmouth-Hitchcock Medical Center Telephone: (603) 653-9899 Email: [email protected] Website: www.dartmouth-hitchcock.org


Transportation Services for Persons with Disabilities and Seniors and P a g e | 4 0 Vehicle Retrofit Programs STAN CASSIDY CENTRE FOR REHABILITATION Website: www.stancassidy.ca 800 Priestman Street Fredericton, NB E3B 0C7

Telephone: (506) 447-4214 Fax: (506) 447-4160

Email: [email protected]

ADAPTIVE DRIVING SERVICE Website: www.stancassidy.ca/home/facilities-and-services/provincial-programs/stan-cassidy-centre-for-rehabilitation/services/assistive-technology-services/adaptive-driving.aspx The Adaptive Driving Service enables persons with disabilities to have safe and accessible transportation in their community. It is a provincial rehabilitation service. Services are directed towards individuals who, as passengers or drivers, may benefit from specially adapted vehicles and/or driver training. The Adaptive Driving Service is not covered by Medicare. Driver Assessment The driving assessment helps to determine the client's potential to begin or resume driving. A comprehensive assessment is completed that considers the client's physical, visual and cognitive/perceptual abilities. Specially adapted equipment may be suggested to help the client to access and control the vehicle. Information on equipment, suppliers and funding sources is provided. Driver training may be recommended. In some situations further testing or alternative transportation may be recommended. Driver Training Driver training may be recommended for those clients who need to learn a new skill and/or improve driving abilities and behaviors. A driver assessment must be completed by the Adaptive Driving Service in order to confirm the client's needs and abilities. Consultation Services The Adaptive Driving Service provides consultation services to clients, caregivers and health professionals regarding vehicle selection and


Transportation Services for Persons with Disabilities and Seniors and P a g e | 4 1 Vehicle Retrofit Programs modification. This may include information on ways to transfer in and out of the vehicle, equipment for lifting and stowing mobility devices (wheelchairs, scooters) and issues related to safety. Information on equipment, suppliers and funding sources is provided. Services Location Clients may be seen at the Stan Cassidy Centre for Rehabilitation in Fredericton on an inpatient or outpatient basis. How to be Referred Document required for driver assessment:

• Physician referral (can be initiated by the therapist or client but a physician is required to sign a referral).

Documents requested for driver assessment (as appropriate):

• Summary of relevant: o occupational therapy findings o physiotherapy findings o psychology reports o speech language pathology reports o Results of visual tests (e.g., optometry, ophthalmology)

EASTER SEALS CANADA Website: www.easterseals.nb.ca Easter Seals New Brunswick 65 Brunswick Street Fredericton, NB E3B 1G5

Telephone/TTY: (506) 458-8739 Fax: (506) 457-2863

Email: [email protected] DISABILITY TRAVEL CARD Easter Seals National Council and its members and/or affiliates are authorized to approve reduced fare tickets allowing persons with permanent disabilities to travel with an attendant* on the lines of Motor Coach Companies that participate in the reduced fare plan and Via Rail. The Disability Travel Card provides identification to a person with a permanent disability, which will allow an adult attendant, traveling with the person with a disability, to travel at no cost.


Transportation Services for Persons with Disabilities and Seniors and P a g e | 4 2Vehicle Retrofit Programs

Reduced fares will be granted to the person with a permanent disability, unable to travel alone, (regardless of age) and accompanied by an adult attendant, if such person with a disability has received authorization from Easter Seals National Council or one of its designated affiliated members.

Only persons with a permanent disability who require a support person when travelling can apply for the card. The applicant must agree to follow the Terms and Conditions for use of the card.

Contact Easter Seals New Brunswick for an application form for the Disability Travel Card or use the copy in Appendix H. The form contains detailed instructions on what information is required and where to send it once completed.

FULL SERVICE GAS STATIONS In an effort to help persons with disabilities become more independent, the Premier’s Council on the Status of Disabled Persons put out a call for the locations of full-serve gas stations. As we acquire new information, we will post these service stations on our web site.

Service stations listed herein either provide full service or full service upon request. Service upon request may be obtained by contacting the service station by phone or by honking your horn. Accessibility to some of these businesses may not be adequate.

IT IS NOT OUR INTENTION TO ENDORSE these businesses, only to advise the public where full-service may be available in various communities.

While every effort is made to insure the accuracy of this information, the Premier's Council makes no representation as to either the completeness or accuracy of this list. Should any errors be encountered or if other full

* An attendant is an individual who accompanies a person with a permanentdisability who cannot travel independently. An attendant will provide that person with required services that are not normally provided by a vehicle operator. These services include assisting the person with eating, administering medication and using the facilities in an on-board washroom or a washroom at a stop.



service gas stations are not included in this list we would ask that this be brought to our attention. Please e-mail the Council at [email protected] with “full service gas stations” in the subject line.

Balmoral Conrad McIntyre 495 des Pionniers Avenue Telephone : 826-2633

Bathurst Bathurst Mainstop

310 Vanier Boulevard Telephone : 545-6107

Bathurst Shell Service Station 1049 Sunset Drive Telephone : 546-1409

Bathurst Ultramar

1395 St. Peter Avenue Telephone : 545-7211

Beardsley Murray’s Irving Exit 191, 198 Beardsley Road Telephone : 328-2994 ext. 2

Berwick Berwick Service Centre

13502 Route 10 Telephone : 433-3411

Blackville Irving 100 Main Street Telephone : 843-7761

Bouctouche Coopérative de Bouctouche

191 Irving Boulevard Telephone : 743-1960

Bouctouche Buctouche Mart 15 Acadie Street Telephone : 743-2293

Bouctouche Bouctouche South


Cap-Pelé Bernard Bourque Garage 2657 Acadie Street Telephone : 577-2281

Caraquet Coop Express

153 St-Pierre Boulevard West Telephone : 727-1921

Caraquet Petro-Canada 2A St-Pierre Blvd East Telephone : 727-1199

Caraquet Centreville Esso

152 St-Pierre Blvd West Telephone : 727-2212



Carlingford Ultramar 540 Route 190 Telephone : 273-9682

Chipman Chipman Tire & Auto Service

266 Main Street Telephone : 339-5919

Dalhousie B & J Auto Service 549 Victoria Street Telephone : 684-3673

Dieppe Circle K

64 Champlain Street Telephone : 855-6820

Dieppe Champlain Esso 65 Champlain Street Telephone : 859-8308

Dundee J & M Degroot Service Station

146 Saint Aubin Road Telephone : 826-9385

Edmundston Accommodation Victoria Enrg., 895 Victoria Street Telephone : 735-0011

Eel River Crossing Eel River Crossing Gas Bar

129 Principale Street Telephone : 826-2233

Elisipogtog Albert Levi Gas & Convenience 20 Big Cove Road Telephone : 523-7261

Fair Isle Godin Services 897 Route 445

Telephone : 776-8800

Fairhaven Welch Store Ltd. 950 Route 772 Telephone : 747-2254

Florenceville Carleton Co-operative Florenceville

9 Main Street Telephone : 392-5587

Fredericton Fredericton Main Irving 95 Main Street Telephone : 458-5645

Fredericton Princess Margaret Irving

536 Riverside Dr. Telephone : 459-5253

Fredericton Co-op 170 Doak Road Telephone : 453-1300

Fredericton PetroCan

20 Royal Road Telephone : 457-0591



Fredericton St. Mary's Gas Bar 150 Cliff Street Telephone : 458-5400

Grand Falls Gilles LaForest Co. Ltd (Esso)

465 Tobique Rd Telephone : 473-4862

Grand Falls Ultramar 555 Madawaska Road Telephone : 473-4862

Grand Manan Russell Food Products


Harcourt Harcourt Variety 7899, Route 126 Telephone : 785-4222

Harvey Harvey Gas Bar

Main Street Telephone : 366-5642

Haut-Lamèque Gauvin Station Service 5183 Rte 113 Telephone : 344-8712

Inkerman Noël Station Service Ltée


Kingsclear First Nation Wulastukw Convenience 77 French Village Road Telephone : 363-5518

Lamèque 63 Principale Street

344-2206

Maisonnette Coop de Caraquet-Maisonnette 1758 Chatillon Street Telephone : 727-2751

Mactaquac Mactaquac Esso Convenience


Meductic Gateway Petroleum 224 RTE 122 Johnson Settlement Telephone : 272-9185

Memramcook YLC Gaudet Ent. Ltd (Ultramar)

603 Central Street Telephone : 758-2555

Millville Ellegood's Service Station Ltd 3946 Route 104 Main Street Telephone : 463-2223

Minto Minto Gas Bar 7 Main Street

Telephone : 327-4227



Miramichi PetroCan 713 King George HWY Telephone : 622-8044

Miramichi Beaubear Coop Miramichi

400 Couglan Street Telephone: 627-0309

Miramichi Courtesy Convenience & Gas Bar 1709 King George Highway Telephone: 622-1661

Moncton Mapleton Esso

5 Plaza Blvd Telephone: 382-6698

Moncton Lyon's Country Store 3295 Mountain Road Telephone: 858-1317

Moncton Magnetic Hill Esso

2731 Mountain Road Telephone: 857-9212

Nackawic Tony's Service Station 15 Carleton Drive Telephone: 575-2470

New Jersey Sunrise Diner Ltd

Route 11 Telephone: 776-8925

Nigadoo Chez Boudreau Ltée 344 Principale Street Telephone: 783-3382

North Tetagouche PetroCan

6 Route 315 Telephone: 548-2284

Norton Norton One Stop 19 Route 124 Telephone: 839-1919

Notre-Dame Notre-Dame Express

3823 Rte 115 Telephone: 576-6681

Oak Bay Red Rooster Country Store 5 Old Bay Road Telephone: 466-0018

Pennfield Stewart’s Village Mart


Penobsquis Hynes Esso 3 Horton Lane Telephone: 433-2468

Petit-Rocher Exit Petit-Rocher

594 Principale Street Telephone: 783-4100



Pokemouche Les Entreprises Robichaud Ltée 11407 Route 11 Telephone: 727-5606

Pont-Landry Magasin Général Landry

5201 Rte 160 Telephone: 395-2478

Port-Elgin Needs Port Elgin 13 Shemogue Road Telephone: 538-7525

Richibucto PetroCan

12 Park Drive Telephone: 523-9505

Rivière Verte Dépanneur du Coin Rioux Inc. 75 Davis Street Telephone: 263-5272

Rogersville Les EntreprisesTthébeau Ltée


Rothesay Shell Service Station 89 Marr Road Telephone: 847-5685

Sackville Tantramar Gas Bar Ltd

4 Cattail Ridge Telephone: 364-9013

Sackville Longs Esso 222 Main Street Telephone: 364-8994

St. Andrews Cummings Convenience

91 Harriet Street Telephone: 529-8816

Saint-Anselme Co-op Express St-Anselme 281 Amirault Street Telephone: 388-5988

Saint-Basile JDP Garage Inc

5A Maillet Street Telephone: 263-5175

St. George Vance's Garage 119 Brunswick Street Telephone: 755-9104

Saint-Jacques Lucien Parent Inc.


Saint John Airport General Store 4105 Loch Lomond Road Telephone: 653-9686

Saint John Saint John Basic

944 Fairville Blvd. 674-1293



Saint John River Road Co-op Grand Bay 3300 Westfield Road Telephone: 738-8421

Saint John Shell Service Station 80 Wellesley Avenue Telephone: 657-7912

Saint John Irving 1233 Loch Lomond Road Telephone: 696-2180

Saint John Rothesay Ave. Esso

570 Rothesay Avenue Telephone: 642-6181

Saint John Church Ave. Esso 15 Church Avenue Telephone: 672-0994

Saint-Paul-de-Kent Coop de Saint-Paul-de-Kent

60 Saint-Paul Cross Telephone: 955-3300

St. Stephen Irving 335 King Street Telephone: 466-4701

Saint-Quentin Marché Irving Saint-Quentin

272 Canada Street Telephone: 235-3311

Shippagan Shell 300 Première Street Telephone: 336-2753

Sussex PetroCan

210 Main Street Telephone: 432-6868

Tide Head Denis Walters Garage The Tide Service Station 256 Restigouche Drive Telephone: 753-3595

Tracadie-Sheila Losier Esso Service


Tracadie-Sheila Coop Régionale de la Baie 3430 Principale Street Telephone: 395-1700

Woodstock Irving

371 Connell St Telephone: 328-8794

Woodstock Wright's Esso 500 Main Street Telephone: 328-2329

Woodstock Murray’s Irving

102 Gallop Street (Connell Road) Telephone: 328-6713



Woodstock First Nation Maliseet Fuels II (Shell) 1 Mowin Lane Telephone: 328-0491

Young’s Cove Youngs Cove Restaurant




Appendices Appendix A

Canada Revenue Agency GST/HST Specially Equipped Motor Vehicle Rebate Application


Protected B when completed

Section A – Identification of vehicle owner

Section B – Type of rebate application – Tick the appropriate box to indicate how you are claiming this rebate. (One box only)

Section C – Rebate for qualifying motor vehiclePart I – Vehicle identification and certified amount

Part II – Rebate calculation – Attach all supporting documentation.

Tax paid on the purchase or importation of a qualifying motor vehicle or a modification service (tax is calculated on the certified amount). For more information, see pages 2 and 3.

Rebate claimed (add lines 1 and 2).

Application filed by the vehicle owner –Purchase of a qualifying motor vehicle or modification service. Mail this completed rebate application to:

Use this form to claim a specially equipped motor vehicle rebate if you paid GST/HST on the purchase of a qualifying motor vehicle, amodification service performed on your motor vehicle, the importation of a qualifying motor vehicle, or the bringing of a qualifying motor vehicle into a participating province from a non-participating province.

NoteThe HST applies in Ontario only after June 2010, in British Columbia only after June 2010 and before April 2013, and in Prince Edward Island only after March 2013.

For more information, see "General Information", on pages 2 and 3.

GST/HST Specially Equipped Motor Vehicle Rebate Application

NC

(Vous pouvez obtenir ce formulaire en français à www.arc.gc.ca/formulaires ou au 1-800-959-7775.)GST518 E (13)

Application filed through GST/HST registered supplier – Purchase of a qualifying motor vehicle. The supplier has paid or credited the rebate directly to the owner of the vehicle. This completed rebate application must be attached to the supplier's GST/HST return for the period in which the rebate was paid or credited to the vehicle owner.

18

17

Supplier's name

Indicate the period in which an adjustment was taken on line 107 of the supplier's GST/HST return.

From to

Day

Day

Year Month Day

MonthYear

DayMonthYear Year Month Day

Business Number

Business Number

Language preferenceTR

TR

FOR INTERNAL USE ONLY

Business address (if different from mailing address) (Apt No – Street No Street name, PO Box, RR) City

Date of transaction

Vehicle owner's last name or name of organization

Vehicle owner's first name and initials (individuals only)

Mailing address (Apt No – Street No Street name, PO Box, RR)

Postal code

Province or territory

For a purchase in Canada, indicate the invoice date. For a vehicle imported into Canada, indicate the importation date. For a vehicle brought into a participating province, indicate the date the vehicle was brought into that province.

Province or territory

City

Telephone

MonthYear

Postal code Telephone

FrenchEnglish

1

2

3

$

$

$

$

Vehicle identification number (VIN)Date of invoice

Canada Revenue AgencySummerside Tax Centre 275 Pope Road Summerside PE C1N 6A2

Signature of supplier or authorized personPrint name of supplier

Enter the part of the purchase price that the supplier certifies as reasonably attributable to the vehicle's specialfeatures or modifications. (Do not include GST/HST or provincial tax.)

Provincial part of HST paid when bringing a qualifying motor vehicle from a non-participating province into a participating province or for a modification service. For more information, see page 3.

Certified amount


Who should complete this form? Use this form to claim a specially equipped motor vehicle rebate for part of the GST/HST paid:

� on the purchase of a qualifying motor vehicle; � on a modification service performed on your motor vehicle; � in respect of the importation of a qualifying motor vehicle; or

� in respect of the bringing of a qualifying motor vehicle into a participating province from a non-participating province.

Generally you must apply for the rebate within four years after the day the tax was paid or became payable, or within four years after the date of importation or of bringing the qualifying vehicle into a participating province. You cannot make more than one application to claim a rebate on a particular vehicle.

If you are the lessee of a qualifying motor vehicle under a written agreement, your lease payments should not include GST/HST on the part that is reasonably attributable to the special features oradaptations. However, if you exercise your purchase option under the lease agreement, you may be able to claim a rebate, based on the certified amount, at that time.

If you paid GST/HST on the part of the lease payment that is attributable to special features or adaptations, you may be able to recover the tax paid in error. For more information, call 1-800-959-5525.

DefinitionsCertified amount – is the part of the purchase price (excluding any GST/HST and provincial tax) that the supplier has certified as being reasonably attributable to special features that have been incorporated into, or adaptations that have been made to, the vehicle for the purpose of its use by or in transporting an individual using a wheelchair, or to equip the vehicle with an auxiliary driving control that allows an individual with a disability to operate it.

Modification service – means a service (including parts) performed on a motor vehicle to specially equip or adapt the vehicle for its use by or in transporting an individual using a wheelchair, or to specially equip the vehicle with an auxiliary driving control to allow an individual with a disability to operate it.

A rebate for modification services is only available where the modification services have been performed on a vehicle outside Canada or outside a participating province and brought back into Canada or into a participating province (subject to tax on the value added). Modification services performed within Canada are zero-rated (in other words, taxable at 0%).

Non-participating province – means a province, territory, or any other area in Canada that is outside the participating provinces.

Participating province – means a province that has harmonized its provincial sales tax with the GST to implement the HST. Participating provinces include New Brunswick, Newfoundland and Labrador, Nova Scotia, Ontario, and Prince Edward Island, but do not include the Nova Scotia offshore area or the Newfoundland offshore area except to the extent that offshore activities, as defined in subsection 123(1) of the Excise Tax Act, are carried on in that area.

NoteBritish Columbia was a participating province from July 1, 2010 until March 31, 2013.

Qualifying motor vehicle – means a motor vehicle that is equipped with a device designed exclusively to assist in placing a wheelchair in the vehicle without having to collapse the wheelchair, or with an auxiliary driving control to facilitate the operation of the vehicle by an individual with a disability.

Qualifying motor vehicles do not include ambulances, but do include vehicles such as para-transit buses and vans that are specially equipped as described above.

Instructions to complete the formSection A Give information about the vehicle owner in this section.

Section B Tick box 17 if the supplier has paid or credited the rebate to the owner of the vehicle. In this case, we will need the supplier's name and Business Number, and the period in which an adjustment was taken on the supplier's GST/HST return. The supplier has to send the completed rebate application to us, signed by the vehicle owner in Section D, along with the GST/HST return for the period indicated.

If the supplier files its GST/HST return electronically, send the completed rebate application to the Summerside Tax Centre at the address shown on the page 3.

NoteIf a supplier pays or credits an amount equal to the amount of the rebate claimed on this application, and the supplier knows or ought to know that the vehicle owner is not entitled to the rebate or that the amount paid or credited is more than the rebate that the vehicle owner is entitled to, they are jointly and severally liable to pay to the Receiver General the amount that was paid or credited for the rebate or the excess amount.

I certify that:� the information in this application, including any accompanying document(s), is, to the best of my knowledge, correct and complete; � the amount claimed has not been previously rebated or refunded; � I understand that this claim for rebate is subject to verification; and

� I understand that the receipts and supporting documentation submitted with this rebate application will not be returned to me.

Section D – Certification of vehicle owner

Third party's name

Section E – Third party authorization

Mailing address (Apt No – Street No Street name, PO Box, RR) City

Country

Province, territory, or state

TelephonePostal or zip code

Page 2

Privacy Act, Personal Information Bank number CRA PPU 090

Print name of vehicle owner or authorized person Signature of vehicle owner or authorized person

Signature of vehicle ownerPrint name of vehicle owner

I certify that the rebate cheque, made payable to the vehicle owner, is to be sent to the third party named in this section, and that I have provided written authorization to the third party.

General Information

Day

DayMonth

Month

Year

Year

Tick box 18 if the vehicle owner is filing the rebate application directly with us. In this case, mail the completed rebate application to:

Canada Revenue Agency Summerside Tax Centre 275 Pope RoadSummerside PE C1N 6A2

Section CPart I – Vehicle identification and certified amount Indicate the vehicle identification number (VIN) as well as the date shown on the purchase invoice. Use a separate rebate application for each vehicle.

The supplier has to indicate the certified amount, excluding any GST/HST and provincial tax, that can reasonably be attributed to the special features described in the definition of qualifying motor vehicle on the previous page. We need the supplier's original signature in this section to process the rebate application.

In the case of a purchase outside Canada, the supplier should enter the certified amount in the same currency as the purchase invoice.

Part II – Rebate calculation Tax paid on the certified amount of the purchase or importation of a qualifying motor vehicle or a modification serviceEnter the actual amount of the GST/HST paid or payable on the certified amount on line 1 "Tax paid on the purchase or importation" in Section C, Part II.

Rebate for the purchase of a qualifying motor vehicle outside CanadaThe vehicle owner has to calculate the rebate based on the portion of the total GST/HST paid in respect of the importation that is attributable to the certified amount from Part I. This is done by dividing the certified amount by the purchase price and multiplying the result by the total GST/HST paid in respect of the importation. Enter the result on line 1 "Tax paid on the purchase or importation"in Section C, Part II.

If you paid duties when you imported the vehicle, the total GST/HST paid includes any GST/HST paid on those duties.

Rebate for a modification service made to a vehicle outside CanadaIndicate the amount of GST/HST that you paid in respect of the importation that is attributable to services that are included in the definition of modification service on the previous page. If you had any other modifications made to your vehicle at the same time that do not fall under the definition of modification service (such as window tinting), you have to deduct any GST/HST that is attributable to those services before you enter the amount on this rebate application. Enter the amount on line 1 "Tax paid on the purchase or importation" in Section C, Part II.

Rebate for the purchase of a qualifying motor vehicle in a non-participating province that is subsequently brought into a participating province The vehicle owner has to calculate the rebate based on the portion of the provincial part of the HST paid that is attributable to the certified amount.

If your calculation includes an amount that the supplier certified on a previous rebate application, we will accept a copy of that application as certification of the amount. To calculate your rebate, multiply the certified amount by the applicable provincial part of the HST rate (7%, 8%, 9%, or 10%). Enter the result on line 2 "Provincial part of HST" in Section C, Part II.

Rebate for a modification service made to a vehicle in a non-participating province that is subsequently brought into a participating province Use this part if you had to register a vehicle in a participating province after it had a modification service performed on it, and you had to pay the provincial part of the HST at that time. To calculate your rebate, multiply the cost of the modification service included in the value you used for provincial vehicle registration by the applicable provincial part of the HST rate (7%, 8%, 9%, or 10%). Enter the result on line 2 "Provincial part of HST" in Section C, Part II.

Rebate ClaimedEnter the total of lines 1 and 2 on line 3.

Section D Print your name. Sign and date the application.

Section E Complete this section if you have authorized a third party to act on your behalf and to receive a rebate cheque made payable to you.

Required documentsSend copies of your receipts and invoices for all purchases recorded with this rebate application. For purchases outside Canada, we need all applicable customs documents. Also, proof of payment of the provincial part of the HST is required if this rebate application is for tax paid upon registering your vehicle in a participating province. You must retain the original receipts and documentation for six years, as this rebate may be subject to further review at a later date.

What if you need help? For more information, go to www.cra.gc.ca/gsthst, or call 1-800-959-8287.

To get our forms and publications, go to www.cra.gc.ca/gsthstpubor call 1-800-959-5525.

Page 3

Transportation Services for Persons with Disabilities and Seniors and P a g e | 5 4 Vehicle Retrofit Programs Appendix B Canada Revenue Agency Application for Refund of Federal Excise Tax on Gasoline


Registered Canadian amateur athletic association

If you selected 4C, are you medically certified as having a permanent mobility impairment to the extent that you cannot safely use public transportation?

Select one of the following options:

7. REFUND OPTIONS

Transfer $ to the following account number and filing period end:

I want to receive the refund by cheque or direct deposit (see instructions on page 2).

Enter account number (15 characters)

Filing period ending

YYYY MM DD

Account number Period covered (YYYY/MM/DD) From To21 Language of communication

FrenchEnglish

3

Registered charity

A.If you selected 4A or 4B, enter the account number of the association or the charity:

4. TYPE OF CLAIMANT – Select the applicable box:

B.

Individual with a permanent mobility impairmentC.

�

�Yes No

6. TOTAL AMOUNT CLAIMED �

Province

EXCISE TAX ACT APPLICATION FOR REFUND OF

FEDERAL EXCISE TAX ON GASOLINE

Business name

Mailing address

City

Postal code

Send this completed application to:CANADA REVENUE AGENCY SUMMERSIDE TAX CENTRE 275 POPE ROAD SUMMERSIDE PE C1N 6E7

I,

certify that the amount claimed or any part of it has not been claimed before and the information on this application is, to the best of my knowledge, correct and complete.

Signature Telephone number Ext.Date (YYYY/MM/DD)

CERTIFICATION

Print name Position or office

Form prescribed by the Minister of National Revenue

XE8 E (12)


You can use one or both calculation methods for the same period. However, you cannot use both methods to claim a refund for the same gasoline purchase.

Does this claim cover more than one vehicle?

5. CALCULATION OF REFUND

Refund type

Refund based on litres (L)

Refund based on kilometres (km)

4935701

4935702 km

L

Refund code

Yes No

Quantity Amount claimed

$0.0015

$0.015

Rate

Ce formulaire existe en français.

RE

Telephone numberContact name Ext.

Page 1 of 2

How the program works: You must fall into one of the three categories identified in Section 4 on page 1. The program allows you to claim a refund for part of the excise tax paid on gasoline at the rate of $0.015 per litre or $0.0015 per kilometre for allowances paid to employees for the operating expenses related to vehicles used for business purposes. To qualify for a refund, the gasoline you buy must be for your use and not for resale. Diesel fuel, heating fuel, propane, gasoline purchased in a foreign country, and aviation fuel do not qualify for an excise tax refund. Also, gasoline you buy for personal use does not qualify for a refund unless you are an individual with a permanent mobility impairment.

When to claim a refund: If your claim is less than $200, you can submit it for each six-month period ending June 30 or December 31. File your claim no later than onemonth after the end of the six-month period. For example, if you are claiming a refund of $150 for the period from January 1 to June 30, submit your claim by July 31. If your claim is $200 or more, you can submit it any time during the year. Please file a maximum of one claim per month. If your refund is for gasoline that you use in different vehicles, you should combine these amounts into one claim.

Documents to keep: Do not submit receipts or other documents with your application. However, you must keep your supporting documents such as invoices, receipts, or vouchers and confirmation-of-use statements, since we may ask you for proof that you purchased the gasoline for which you are claiming a refund. Your documents must contain enough information to allow us to verify your gasoline tax refund claim.Each proof of purchase must include the supplier's name, the purchase date, the quantity, and the price of gasoline purchased. We do not accept estimates for missing records. You can claim a refund for allowances that you paid your employees for the operating expenses related to the use of their personal vehicle for business purposes. You must keep copies of expense account statements that show kilometres and proof of payment to the employees.If you send receipts or vouchers to other government departments or agencies, you must keep copies or other written proof to support the application you file with us. You must keep all records and account books in Canada for six years from the end of the year to which they relate. If you are an organization or association, you must keep your books and records at your place of business in Canada.

Note:Subsection 68.16(1) of the Excise Tax Act specifies that a refund will not be paid unless you file this application within two (2) years after the gasoline was purchased.

Please allow us up to 60 days to process your application.

If you want an individual such as an accountant, a lawyer, an employee or a firm to be authorized to deal with the CRA on your behalf regarding this application, complete form RC59, Business Consent Form, which is available at www.cra.gc.ca/E/pbg/tf/rc59/ if you have not already done so. Select the RE (excise tax) program identifier. Attach the completed consent form to this application for refund. Your consent will stay in effect until you cancel it or until it reaches the expiry date you provided. If you are a business owner, instead of submitting a consent form, you can give this consent by going online at www.cra.gc.ca/mybusinessaccount.

This form is available on our Web site at www.cra.gc.ca/E/pbg/ef/xe8/.

If you have any questions about filing this application for a refund, you can call us toll free from anywhere in Canada or the United States at1-877-432-5472 (bilingual service).

INSTRUCTIONS FOR COMPLETING PAGE 1

Enter the legal name and mailing address of the registered Canadian amateur athletic association,registered charity, or individual with the permanent mobility impairment.

Enter the account number (that includes the letters RE) that was assigned to you for refund purposes. Leave this section blank if this is your first application for a refund or if you do not have an excise tax account number.

1. Account number

Enter the date of the first and last purchase of gasoline covered by this claim.2. Period covered

Check the appropriate box to indicate your language preference for communicating with us. 3. Language of communication

Check the appropriate box to indicate the category for which you are claiming a refund. If you have a permanent mobility impairment, and this is your first time filing an application, you should submit a copy of your medical certificate certified by a qualified medical practitioner.

4. Type of claimant

You can use one or both calculation methods for the same claim period. However, you cannot use both methods to claim a refund for the same gasoline purchase.

5. Calculation of refund

Add the amounts entered in Section 5 and enter the total in Section 6.6. Total amount claimed

Select the option that describes how you want your refund issued or applied. If this is the first time you are requesting direct deposit or if your direct deposit information has changed, complete form E664, DirectDeposit Request, which can be found at www.cra.gc.ca/E/pbg/ef/e664/.

7. Refund options

Enter the name and telephone number of the individual we may contact for information about the application.Contact name and telephone number

Identification

Certification For registered charities and registered Canadian amateur athletic associations, an authorized person must sign this application, certifying that the information provided is correct and complete.An individual with a permanent mobility impairment claiming the refund must sign this application, certifying that the information provided is correct and complete. We will only process the application if this section has been completed.

Page 2 of 2

��

�

�

�

�

�

�

�

�

�

Personal information provided on this form is protected under the provisions of the PrivacyAct and is maintained under Personal Information Bank CRA PPU 051 and CRA PPU 052.

Transportation Services for Persons with Disabilities and Seniors and P a g e | 5 6 Vehicle Retrofit Programs Appendix C Department of Finance Application for Refund – Harmonized Sales Tax (HST – R – 02)


MAIL TO / ADRESSER SA DEMANDE À :

APPLICATION FOR REFUND

DEMANDE DE REMBOURSEMENT

HARMONIZED SALES TAX

TAXE DE VENTE HARMONISÉE HST-R-02 (2013/08)

Department of Finance Revenue and Taxation Division P.O. Box 3000, Fredericton, NB E3B 5G5 Ministère des Finances Division du revenu et de l’impôt C.P. 3000, Fredericton, NB E3B 5G5

Name/Nom

Amount of Refund Claim /

Montant de la demande de

remboursement

Address/Adresse

$___________________________

Reason for Refund Claim: / Motif de la demande de remboursement :

Before mailing, please refer to the back of this application. If the claim you are applying for is not indicated on this form,

please contact the Department of Finance at (800) 669-7070. /

Veuillez vous référer au verso avant de poster la demande. Si le type de votre réclamation n’est pas indiqué au verso,

veuillez communiquer avec le Ministère des Finances au (800) 669-7070.

Date ___________________________20____

Telephone / Téléphone _____________________ Signature: _____________________________________

(Signature of applicant / Signature du requérant)

Note / Nota :

Refund claims are limited to a period of three (3) years from the day on which the overpayment of tax was made. / Il faut présenter les demandes de remboursement dans les trois années suivant la date à laquelle le trop-payé de la taxe a été fait.

“Every Person Who Makes a False Statement in Any Form Provided For Under This Act, Is Guilty Of An Offence, R.S., C.S- 10, S.43” “Est coupable d’une infraction quiconque fait une fausse déclaration dans toute formule prévue par la présente Loi., R.S., C.S-10,S.43”

The personal information on this refund application is being collected under the authority of the Harmonized Sales Tax Act, and will be used for the purposes of determining eligibility for a refund of the provincial vehicle tax and or the tangible personal property tax. If you have any questions regarding the collection and use of this information, please contact the Manager Tax Accounting, Refunds and Financial Analysis Department of Finance, P. O.

Box 3000, Fredericton, NB E3B 5G5. Phone: 1-800-669-7070 or e‐mail [email protected]. Les renseignements personnels que contient la présente demande de remboursement sont recueillis en vertu de la Loi sur la taxe de vente harmonisée, et seront utilisés dans le but de déterminer l'admissibilité à un remboursement de la taxe provinciale sure les véhicules et/ou la taxe sure les biens personnels désignés. Vous pouvez faire part de vos questions sur la collecte et l'utilisation de ces renseignements au gestionnaire des paiements et remboursements d’impôt, analyse financière, Ministère des Finances, C.P. 3000, Fredericton (N.-B.) E3B 5G5. N

o de téléphone :

1-800-669-7070, adresse électronique : [email protected].

For Office Use Only/

Réservé à l’usage du bureau

Rebate No. / No de remboursement Loaded By / Entré par Approved / Approuvé

mailto:[email protected]


COMMON TYPES OF REFUND CLAIMS

RESEARCH & DEVELOPMENT REBATE

The Province of New Brunswick may refund the 8% provincial portion of the HST paid upon a supply of property and services used directly in research and

development by a university.

Necessary Documentation:

(a) Certification that the supply of property and services is used directly in research and development by a university;

(b) Description of research/development project to be performed;

(c) University Department Head approval;

(d) Budget and material breakdown of intended project; and

(e) Supporting invoices for materials obtained to complete the project.

DISABILITY REBATE

The Province of New Brunswick may refund the 8% provincial portion of the HST paid upon the purchase of a passenger vehicle, truck, or van by persons

with disabilities if:

the passenger vehicle, truck, or van is specially equipped with a device to enable a wheelchair or scooter to enter or leave the vehicle (e.g., hydraulic lifts); or

the passenger vehicle, truck, or van is specially equipped with auxiliary driving controls that are used to facilitate the operation of the vehicle (does not include

spinner knobs); and

the passenger vehicle, truck, or van is not operated by any person for the purpose of earning a profit for any person or as part of any undertaking carried on for

gain; and

the claimant is not eligible for any other GST/HST credit or rebate related to this purchase.


(a) proof that HST was paid (copy of Bill of Sale)

(b) proof that the passenger vehicle, truck, or van is specially equipped with a device to enable a wheelchair or scooter to enter or leave the vehicle; or

(c) proof that the passenger vehicle, truck, or van is specially equipped with auxiliary driving controls that are used to facilitate the operation of the vehicle; and

(d) a letter from a medical practitioner certifying that the person is disabled.

TYPES COURANTS DE DEMANDES DE REMBOURSEMENT

REMBOURSEMENT POUR LA RECHERCHE ET L'AVANCEMENT

Le gouvernement du Nouveau-Brunswick peut rembourser la portion provinciale de 8 % de la TVH sur la fourniture de biens et de services utilisés

directement pour la recherche et l'avancement par une université.

Documents nécessaires :

(a) Attestation établissant que la fourniture porte sur des biens et services utilisés directement pour la recherche et l'avancement par une université;

(b) Description du projet de recherche ou d'avancement qui sera réalisé;

(c) Approbation du chef de département de l'université;

(d) Budget et ventilation des fournitures pour le projet escompté; et

(e) Factures à l'appui des fournitures obtenues pour réaliser le projet.

REMBOURSEMENT AUX PERSONNES HANDICAPÉES

Le gouvernement du Nouveau-Brunswick peut rembourser la portion provinciale de 8 % de la TVH payée à l'achat d'une voiture particulière, un camion ou

une camionnette par des personnes handicapées dans les conditions suivantes :

la voiture particulière, le camion ou la camionnette est muni d'un dispositif permettant à un fauteuil roulant ou à un fauteuil tricycle d'y monter et d'en descendre

(p.ex. : mécanismes élévateurs hydrauliques); ou

la voiture particulière, le camion ou la camionnette est muni de mécanismes auxiliaires utilisés pour faciliter la conduite de le véhicule (ne comprend pas les

poignées de volant); et

la voiture particulière, le camion ou la camionnette n'est pas utilisé par toute autre personne à des fins lucratives au bénéfice d’une autre personne ou pour une

entreprise à but lucratif; et

le demandeur n'est pas éligible pour autre crédit ou remboursement de TPS/TVH ayant trait à cet achat.

Documents nécessaires :

(a) Preuve que la TVH a été payée (copie de l’acte de vente)

(b) Preuve que la voiture particulière, le camion ou la camionnette est muni d'un dispositif permettant à un fauteuil roulant ou à un fauteuil tricycle d'y monter et d'en

descendre; ou

(c) Preuve que la voiture particulière, le camion ou la camionnette est muni de mécanismes auxiliaires qui facilite la conduite de le véhicule; et

(d) Lettre d'un médecin attestant que la personne est handicapée.

Transportation Services for Persons with Disabilities and Seniors and P a g e | 5 8 Vehicle Retrofit Programs Appendix D Department of Finance Application for Refund – Provincial Vehicle Tax and Tangible Personal Property Tax (PVT – R – 01)


MAIL TO / ADRESSER SA DEMANDE À :

APPLICATION FOR REFUND

DEMANDE DE REMBOURSEMENT

PROVINCIAL VEHICLE TAX and

TANGIBLE PERSONAL PROPERTY TAX

TAXE PROVINCIALE SUR LES VÉHICULES et

TAXE SUR LES BIENS PERSONNELS DÉSIGNÉS PVT-R-01 (2013/08)

Department of Finance Revenue and Taxation Division P.O. Box 3000, Fredericton, NB E3B 5G5 Ministère des Finances Division du revenu et de l’impôt C.P. 3000, Fredericton, NB E3B 5G5

Name/Nom

Amount of Refund Claim /

Montant de la demande de

remboursement

Address/Adresse

$___________________________

Reason for Refund Claim: / Motif de la demande de remboursement :

Before mailing, please refer to the back of this application. If the claim you are applying for is not indicated on this form,

please contact the Department of Finance at (800) 669-7070. /

Veuillez vous référer au verso avant de poster la demande. Si le type de votre réclamation n’est pas indiqué au verso,

veuillez communiquer avec le Ministère des Finances au (800) 669-7070.

Date ___________________________20____

Telephone / Téléphone _____________________ Signature: _____________________________________

(Signature of applicant / Signature du requérant)

Note / Nota :

Refund claims are limited to a period of three (3) years from the day on which the overpayment of tax was made. / Il faut présenter les demandes de remboursement dans les trois années suivant la date à laquelle le trop-payé de la taxe a été fait.

“Every Person Who Makes a False Statement in Any Form Provided For Under This Act, Is Guilty Of An Offence, R.S., C.S- 10, S.43” “Est coupable d’une infraction quiconque fait une fausse déclaration dans toute formule prévue par la présente Loi., R.S., C.S-10,S.43”

The personal information on this refund application is being collected under the authority of the Harmonized Sales Tax Act, and will be used for the purposes of determining eligibility for a refund of the provincial vehicle tax and or the tangible personal property tax. If you have any questions regarding the collection and use of this information, please contact the Manager Tax Accounting, Refunds and Financial Analysis Department of Finance, P. O.

Box 3000, Fredericton, NB E3B 5G5. Phone: 1-800-669-7070 or e‐mail [email protected]. Les renseignements personnels que contient la présente demande de remboursement sont recueillis en vertu de la Loi sur la taxe de vente harmonisée, et seront utilisés dans le but de déterminer l'admissibilité à un remboursement de la taxe provinciale sure les véhicules et/ou la taxe sure les biens personnels désignés. Vous pouvez faire part de vos questions sur la collecte et l'utilisation de ces renseignements au gestionnaire des paiements et remboursements d’impôt, analyse financière, Ministère des Finances, C.P. 3000, Fredericton (N.-B.) E3B 5G5. N

o de téléphone :

1-800-669-7070, adresse électronique : [email protected].

For Office Use Only/

Réservé à l’usage du bureau

Rebate No. / No de remboursement Loaded By / Entré par Approved / Approuvé



COMMON TYPES OF REFUND CLAIMS

CANCELLED SALE: Where a sale transaction is cancelled and the motor vehicle, boat or aircraft is returned to the original owner for a refund, the buyer may apply for a

refund of the Provincial Vehicle Tax (PVT) or the Tangible Personal Property Tax (TPPT) paid to the Provincial Government.


(a) Copy of Bill of Sale and New Brunswick Tax Receipt;

(b) Copies of registrations providing proof of the old and present ownership;

(c) Proof of payment of the Provincial Vehicle Tax (PVT) or the Tangible Personal Property Tax (TPPT) (e.g., NB tax receipt); and

(d) Proof of refund on canceled sales (e.g., written acknowledgement from original owner that the motor vehicle, boat or aircraft was returned and all money

refunded).

APPRAISAL: Where a person pays the Provincial Vehicle Tax (PVT) on the private sale transfer of a motor vehicle and subsequently within 14 days of registration,

obtains an appraisal showing a lesser value, a person may submit an application for a refund on the difference between the taxed value and the purchase price or the

appraised value, whichever is greater.



(b) Proof of payment of the Provincial Vehicle Tax (PVT), usually a copy of the registration certificate showing amount of the tax paid; and

(c) Completed motor vehicle appraisal form (Note: The appraisal must be dated by the appraiser within fourteen days of registration).

DISABILITY: The Province of New Brunswick may refund the Provincial Vehicle Tax (PVT) on private sale transactions for persons with disabilities if:

the passenger vehicle, truck, or van is specially equipped with a device to enable a wheelchair or scooter to enter or leave the vehicle (e.g. hydraulic lifts); or

the passenger vehicle, truck, or van is specially equipped with auxiliary driving controls that are used to facilitate the operation of the vehicle (does not include

spinner knobs); and

the passenger vehicle, truck, or van is not operated by any person for the purpose of earning a profit for any person or as part of any undertaking carried on for

gain; and

the claimant is not eligible for any other GST/HST credit or rebate related to this purchase.



(b) Proof that the passenger vehicle, truck, or van is specially equipped with a device to enable a wheelchair or scooter to enter or leave the vehicle; or

(c) Proof that the passenger vehicle, truck, or van is fitted with auxiliary driving controls that are used to facilitate the operation of the vehicle; and

(d) A letter from a medical practitioner certifying person is disabled.

TAX COLLECTED IN ERROR:



(b) Reason for tax collected in error.

30 DAY REMOVAL: Where a motor vehicle, boat or aircraft is purchased by way of private sale, the Provincial Vehicle Tax (PVT) or the Tangible Personal Property Tax

(TPPT) is paid and the purchaser subsequently removes it from the province, registers it and pays the applicable taxes in another jurisdiction within 30 calendar days

of purchase, the purchaser may apply for a refund of the tax paid.


(a) Copy of Bill of Sale;

(b) Copy of NB Provincial Vehicle Tax (PVT) or the Tangible Personal Property Tax (TPPT) receipt;

(c) Copy of Vehicle Registration, in the purchasers name, from the other jurisdiction where the motor vehicle is registered dated within 30 calendar days of purchase;

and

(d) Copy of the tax paid receipt, where applicable, from the other jurisdiction dated within 30 calendar days of purchase.

7 DAY RESALE: Where a motor vehicle, boat or aircraft is purchased by way of private sale, the Provincial Vehicle Tax (PVT) or Tangible Personal Property Tax

(TPPT) is paid and subsequently, the motor vehicle, boat or aircraft is resold and the new owner registers and pays the applicable tax within seven calendar days of

the original purchase, the original purchaser may apply for a refund of the tax paid.


(a) Copy of the original Bill of Sale;

(b) Copy of NB Provincial Vehicle Tax (PVT) or the Tangible Personal Property Tax (TPPT) receipt; and

(c) Proof of resale, registration in the new owners name and payment of taxes, where applicable, within seven calendar days of the original purchase.

NOTE: Motor vehicles, boat or aircraft applied as a trade-in in another transaction within the time frame are not eligible.

TYPES COURANTS DE DEMANDES DE REMBOURSEMENT

ANNULATION DE VENTE : Lorsqu'une transaction de vente est annulée et que le véhicule, bateau ou aéronef est retourné au propriétaire initial pour un remboursement,

l'acheteur peut demander un remboursement de la taxe provinciale sur les véhicules (TPV) ou de la taxe sur les biens personnels désignés (TBPD) payée au

gouvernement provincial.

Documents exigés :

(a) Copie de l'acte de vente et du reçu de la taxe de vente du Nouveau-Brunswick;

(b) Des copies des certificats d'immatriculation servant de preuve de la propriété antérieure et actuelle;

(c) Une preuve du paiement de la taxe provincial sur les véhicules (TPV), ou de la taxe sur les biens personnels désignés (TBPD) (p.ex., reçu de la taxe de vente du

NB); et

(d) Une preuve du remboursement au titre de la vente annulée (c'est-à-dire une reconnaissance par écrit du propriétaire initial que le véhicule, le bateau ou l’aéronef

a été retourné et que la somme complète a été remboursée).

ÉVALUATION : Une personne qui paie la taxe provinciale sur les véhicules sur une vente privée d’un véhicule à moteur et qui par la suite obtient dans les 14 jours de

l’immatriculation une évaluation indiquant une valeur inférieure, peut soumettre une demande de remboursement pour la différence entre la valeur taxée et le prix

d’achat ou le montant de l’évaluation, le montant le plus élevé étant retenu.

Documents exigés :


(b) Preuve du paiement de la taxe provinciale sur les véhicules (TPV), habituellement une copie du certificat d’immatriculation indiquant le montant de la taxe payée;

et

(c) L’évaluation dûment remplie (nota : l’évaluation doit être datée dans les 14 jours de l’immatriculation).

REMBOURSEMENT AUX PERSONNES HANDICAPÉES : Lors de l'achat d'une voiture particulière, un camion ou une camionnette (vente privée) dans la province du Nouveau-

Brunswick, le gouvernement du Nouveau-Brunswick peut rembourser la taxe provinciale sur les véhicules (TPV) aux personnes handicapées si :

la voiture particulière, le camion ou la camionnette est muni d'un dispositif permettant à un fauteuil roulant ou à un fauteuil tricycle d'y monter et d'en descendre

(p.ex. : mécanismes élévateurs hydrauliques); ou

la voiture particulière, le camion ou la camionnette est muni de mécanismes auxiliaires utilisés pour faciliter la conduite de le véhicule (ne comprend pas les

poignées de volant); et

la voiture particulière, le camion ou la camionnette n'est pas utilisé par toute autre personne à des fins lucratives au bénéfice d’une autre personne ou pour une

entreprise à but lucratif; et

le demandeur n'est pas éligible pour autre crédit ou remboursement de TPS/TVH ayant trait à cet achat.

Documents exigés :

(a) Preuve que la TVH a été payée (copie de l’acte de vente)

(b) Preuve que la voiture particulière, le camion ou la camionnette est muni d'un dispositif permettant à un fauteuil roulant ou à un fauteuil tricycle d'y monter et d'en

descendre; ou

(c) Preuve que la voiture particulière, le camion ou la camionnette est muni de mécanismes auxiliaires qui facilite la conduite de le véhicule; et

(d) Lettre d'un médecin attestant que la personne est handicapée.

TAXE PERÇUE PAR ERREUR :

Documents exigés :


(b) Raison pour laquelle la taxe a été perçue par erreur.

ENLÈVEMENT DANS LES 30 JOURS : Lorsqu'un véhicule à moteur, un bateau ou un aéronef est acheté par voie d'une vente privée, que la taxe provinciale sur les

véhicules (TPV) ou la taxe sur les biens personnels désignés (TBPD) est acquittée et que par la suite l’acheteur l’enlève de la province, l’immatricule et acquitte la

taxe applicable dans une autre juridiction dans les 30 jours consécutifs de l'achat, l'acheteur peut présenter une demande de remboursement de la taxe payée.

Documents exigés :

(a) Copie de l'acte de vente;

(b) Copie du reçu de la taxe provincial du Nouveau-Brunswick sur les véhicules (TPV), ou la taxe sur les biens personnels désignés (TBPD);

(c) Copie de l’immatriculation du véhicule au non de l’acheteur délivrée dans la juridiction oû le véhicule est immatriculé et daté dans les 30 jours consécutifs de

l’achat; et

(d) Copie du reçu de la taxe payée, si applicable, de l’autre juridiction daté dans les 30 jours consécutifs de l’achat.

REVENTE DANS LES 7 JOURS : Lorsqu'un véhicule à moteur, un bateau ou un aéronef est acheté par voie d'une vente privée, que la taxe provinciale sur les véhicules

(TPV) ou la taxe sur les biens personnels désignés (TBPD) est acquittée et que le véhicule, le bateau ou l’aéronef est revendu et le nouveau propriétaire immatricule

et acquitte la taxe applicable dans les sept jours consécutifs de l’achat initial, l'acheteur initial peut présenter une demande de remboursement de la taxe payée.

Documents exigés :

(a) Copie de l'acte de vente initial

(b) Copie du reçu de la taxe provinciale du Nouveau-Brunswick sur les véhicules (TPV), ou la taxe sur les biens personnels désignés (TBPD);

(c) Une preuve de la revente et de l’immatriculation au non du nouveau propriétaire et le paiement de taxe, si applicable, dans les sept jours consécutifs de l’achat

initial.

REMARQUE : Les véhicules à moteur, les bateaux ou les aéronefs repris, dans le délai mentionné, lors d’une autre transaction ne sont pas admissibles.

Transportation Services for Persons with Disabilities and Seniors and P a g e | 6 0 Vehicle Retrofit Programs Appendix E Service New Brunswick Application for Disabled Parking Permit


APPLICATION FOR DISABLED PARKING PERMITDEMANDE DE PERMIS DE STATIONNEMENT POUR PERSONNE HANDICAPÉE(PLEASE PRINT / EN LETTRES MOULÉES)

78-9300 (11/08)

Permanent - Permit #Permanent - Permis n°

Temporary - Limited mobility temporaryTemporaire - Mobilité limitée temporairement

Name:Nom :

Last / Nom First / Prénom Initial / Initiale

Address:Adresse :

Street, Route, Apt. # / Rue, route, app. City / Ville Postal Code / Code postal

I am aware of my rights, duties, and responsibilities regarding theuse and possession of a disabled parking placard and penaltiesprovided for disabled parking infractions.

Je connais mes droits, mes obligations et mes responsabilitésconcernant l’utilisation et la possession d’une carte destationnement pour personne handicapée ainsi que les pénalitésprévues en cas d’infraction au règlement.

Signature Date

Medical Certificate must be completed by a) LicensedPhysician, b) Occupational Therapist, c) Physiotherapist ord) Nurse Practitioner

Le certificat médical doit être rempli par une personnemembre de l’une des professions suivantes : a) médecin b)ergothérapeute c) physiothérapeute d) infirmiè(e)praticien(ne)

The applicant named above has the following medical condition:Please check one of the following:

La personne susnommée est atteinte des troubles médicauxsuivants :

Physical impairment, which limits personal mobility and resultsin an inability to travel unassisted more than Fifty (50) metreswithout the use of a wheel chair, crutch, walker, lower limbprosthetic, orthotic or other assistive device.

Severe respiratory and/or cardiac conditions which result insevere shortness of breath and/or pain after minimal physcialactivity.

Déficience physique limitant la mobilité personnelle etentraînant de se déplacer sans aide sur une distance de plusde 50 mètres sans l’utilisation d’un fauteuil roulant, de béquilles,d’une marchette, d’une prothèse ou orthèse d’un membreinférieur ou d’un autre accessoire fonctionnel.

Troubles respiratoires ou cardiaques graves provoquant desdifficultés respiratoires importantes ou des douleurs intensesà la suite d’un effort physique minimal.

Temporary Permit applications must show expected date of recovery:Il faut indiquer la date prévue du retour à l’état de santé normal :

I certify that the applicant above meets the medical criteriaestablished for the issuance of a disabled parking permit.

Print/En lettres moulées :

J’atteste que la personne susnommée répond aux critèresmédicaux l’autorisant à obtenir un permis de stationnement pourpersonne handicapée.

Certifier’s Name/CompanyNom du professionnel/de l’entreprise

Signature Date

Address:Adresse :

Street, P.O. Box, Suite Number/ Rue, case postale, n° de la pièce City / Ville Postal Code / Code postal

Issued under the authority of a visually obvious disability as per the mobility restrictionsdescribed above.Carte délivrée sur la foi d’une incapacité évidente ou en fonction des limitations à la mobilitésusmentionnées.

For Issuing Office Use Only / Réservé au bureau de délivrance

InitialsInitiales

Issued DateDate Emis

OfficeBureau #

Issued DateDate Emis

D/J M/M Y/AIssued DateDate Emis

D/J M/M Y/A

D/J M/M Y/A

Ye sOui

NoNon

Section 3

Section 2

Section 1

PhysicianMédecin

Occupational TherapistErgothérapeute

PhysiotherapistPhysiothérapeute

Nurse PractitionerInfirmièr(e) praticien(ne)

PERMIS ET PLACARD DE STATIONNEMENTPOUR PERSONNE(S) AYANT UN HANDICAP

La province émet des PERMIS et des PLACARDS DESTATIONNEMENT montrant le symbole internationald'accessibilité et donnant droit aux aires de stationnementréservées aux personnes ayant un handicap. Le PERMISet le PLACARD n'exemptent pas le propriétaire duvéhicule des frais de stationnement.

CE PROGRAMME A POUR BUT DE RÉSERVER LESPERMIS ET LES PLACARDS DE STATIONNEMENTPOUR PERSONNES AYANT UN HANDICAP AUXPERSONNES AYANT UNE MOBILITÉCONSIDÉRABLEMENT RÉDUITE, EN RAISON DE LAPARALYSIE, DE L'AMPUTATION D'UN MEMBREINFÉRIEUR, D'UNE MALADIE CARDIAQUE OUPULMONAIRE OU AUTRES PROBLÈMES DE SANTÉQUI FONT EN SORTE QU'UNE PERSONNEÉPROUVERAIT DES DIFFICULTÉS À MARCHER SANSAIDE SUR UNE DISTANCE DE PLUS DE 50 MÈTRESÀ L'EXTÉRIEUR.

Les cartes de stationnement pour personnehandicapée peuvent être accordées pour une périodemaximale de cinq ans.

PARKING PERMIT AND PLACARDFOR PERSON(S) HAVING A DISABILITY

The Province issues PARKING PERMITS andPLACARDS displaying the international disabled symbolto promote special parking areas for persons having adisability. The PERMIT and PLACARD do not exemptthe vehicle-owner from payment of any parking fees.

THE INTENT OF THIS PROGRAM IS TO LIMITELIGIBILITY FOR THE PARKING PERMIT ANDPLACARD FOR PERSON(S) HAVING A DISABILITYTO THOSE SITUATIONS WHERE THE PERSON HASA SIGNIFICANT DEGREE OF MOBILITY IMPAIRMENTCAUSED BY PARALYSIS, LOWER LIMB AMPUTATION,HEART OR LUNG DISEASE OR OTHER HEALTHPROBLEMS SUCH THAT THE PERSON WOULD HAVEDIFFICULTY WALKING UNASSISTED MORE THAN 50METRES IN OUTDOOR WEATHER CONDITIONS.

Disabled placards may be issued for a period up toa maximum of five years.

The PARKING PERMIT and PLACARD can be obtainedwithout charge at any Service N.B. Centre, or by applyingto:

Vous pouvez obtenir le PERMIS et le PLACARD DESTATIONNEMENT sans frais en vous adressant à un ServicesNouveau-Brunswick ou en envoyant une demande à l'adressesuivante :

Service N.B.P.O. Box 1998, 432 Queen Street,Fredericton, N.B. E3B 5G4

Services Nouveau-BrunswickCase postale 1998, 432, rue Queen,Fredericton, (N-B) E3B 5G4

CONDITIONS CONDITIONS

Placards are available for the transport of anyphysically disabled person whose physicalimpairment results in the inability to travel unassistedmore than fifty (50) metres without the use of;

(a) wheelchair(b) walker(c) crutch(es)(d) lower limb prosthetic, orthotic or other assistivedevice(e) severe respiratory and/or cardiac conditions whichresults in severe shortness of breath and/or painafter minimal physical activity.

Eligibility of a disabled applicant, when not visiblyapparent, must be certified by a medical practitioner.

1A.

The parking placard is only to be used when the vehiclein question actually has one or more passengers whowould have a disability serious enough to qualify for thespecial parking privileges of the placard.

DISPLAYING OF PLACARD

The placard shall be displayed by hanging it from theinterior rear-view mirror of the vehicle. This placard mustbe displayed only when actually in use for the specificbenefit of the person having a disability. Failure toconform to this requirement may result in the cancellationof the permit and of the placard.

SURRENDER OF PERMIT AND PLACARD

When a permit and placard are no longer required by theholder, the permit and placard must be surrendered to aService New Brunswick Office or returned to Licensingand Registration Branch, Department of Public Safety,Fredericton, N.B.

Le placard de stationnement doit être utiliisé uniquementlorsque le véhicule transporte un ou plusieurs passagersqui ont un handicap assez grave pour avoir droit auplacard de stationnement.

AFFICHAGE DU PLACARD

Il faut afficher le placard en le suspendant au rétroviseurdu véhicule. Il doit être affiché uniquement lorsque levéhicule sert au transport d'une personne ayant unhandicap. Le non-respect de cette exigence peutentraîner l'annulation du permis et du placard.

REMISE DU PERMIS ET DU PLACARD

Lorsque les personnes à qu'ils ont été remis n'en ont plusbesoin, le permis et la carte doivent être retournés aubureau de Services Nouveau-Brunswick ou à la Directiondes licences et des enregistrements du ministère de la Sécurité publique à Fredericton (Nouveau-Brunswick).

Placards are available upon application to; a disabled person; individuals; or companies/organizationsthat provides transportation service to a disabledperson on a regular basis.

B.

NOTE TO LICENSED HEALTH PROFESSIONAL

Please checkmark one of the two blocks in Section Two.

AVIS AUX PROFESSIONNELS DE LA SANTÉAUTORISÉS

Veuillez cocher une des deux cases dans la SectionDeux.

78-9300 (11/02)

Les cartes sont disponibles pour le transport d'unepersonne handicapée physiquement dont ladéficience physique l'empêche de se déplacer surune distance de plus de cinquante mètres sansl'utilisation :

a) d'un fauteuil roulant,b) d'une marchette,c) de béquilles,d) d'une prothèse ou orthèse d'un membre infèrieurou d'un autre accessoire fonctionnel,e) ou qui atteinte de troubles respiratoires oucardiaques graves provoquant des difficultésrespiratoires importantes ou des douleurs intenses àla suite d'un effort physique minimal.

Un médecin doit attester de l'admissibilité d'unrequérant handicapé si l'incapacité n'est facilementobservable.

1A.

Les cartes sont accessibles, sur demande : à une personne handicapée, à des particuliers ou à des entreprises ou organismesqui offrent régulièrement un service de transport àune personne handicapée.

B.

Transportation Services for Persons with Disabilities and Seniors and P a g e | 6 2 Vehicle Retrofit Programs Appendix F Department of Transportation and Infrastructure Application for Capital Assistance – Vehicle Retrofit Program


APPLICATION FOR CAPITAL ASSISTANCE

VEHICLE RETROFIT PROGRAM

DEPARTMENT OF TRANSPORTATION AND INFRASTRUCTURE

PLEASE TYPE OR PRINT

DEMANDE D’AIDE FINANCIÈRE

PROGRAMME DE VÉHICULES ADAPTÉS MINISTÈRE DES TRANSPORTS ET DE

L’INFRASTRUCTURE

ÉCRIRE À LA MACHINE OU EN CARACTÈRES D’IMPRIMERIE

Individual / Particulier Organization / organisme Business (Registration) Number / Numéro d’affaires

(enregistrement)

A. PERSON WITH DISABILITY A. PERSONNE HANDICAPÉE Name /Nom

Family Name at Birth / Nom de famille à la naissance

Date of Birth / Date de naissance (mm/dd/yyyy)/(mm/jj/aa)

Address - Postal Code / Adresse - code postal

Medicare Number / Numéro d’assurance-maladie

Vehicle Identification Number (serial no.) / Numéro d’identification du véhicule (no de série)

Have you received a previous grant under this program? Avez-vous déjà reçu une subvention dans le cadre de ce programme?

No/Non Yes/Oui If Yes when ? / Si oui, quand? Amount ? / Montant? Are you receiving funding from any other sources ? / Recevez-vous du fiancement à partir d’autres sourses ? Yes/Oui No/Non

If Yes, identify source / Si oui, précisez la source Telephone / Téléphone

Home / Domicile Work / Bureau

B. APPLICANT (If different from Section A) B. REQUÉRANT (S’il diffère de la section A) Name / Nom Address - Postal Code / Adresse - code postal

Telephone / Téléphone

Home / Domicile Work / Bureau

Relationship to disabled person / Lien avec la personne handicapée :

Parent / Parent

Guardian / Tuteur Other / autre

Do you authorize the Vehicle Retrofit Coordinator to discuss your application with the Occupational Therapist or Physician identified on this application form ? / Autorisez-vous le coordonnatrice du Programme de véhicules adaptés à discuter de votre demande avec l’ergothérapeute ou le médecin dont le nom apparaît sur le formulaire de demande?

No/Non Yes/Oui When corresponding, do you wish to be addressed / Langue préférée pour la correspondance : In English / en anglais In French / en français

ANSWER QUESTIONS COMPLETELY AND PROVIDE APPROPRIATE ATTACHMENTS. THE COMPLETENESS OF INFORMATION PROVIDED WILL CONTRIBUTE TO EVALUATION OF APPLICATIONS. ATTACH ADDITIONAL SHEETS AS REQUIRED.

RÉPONDRE À TOUTES LES QUESTIONS ET FOURNIR LES PIÈCES APPROPRIÉES. L’EXHAUSTIVITÉ DES RENSEIGNEMENTS FOURNIS FACILITERA L’ÉVALUATION DES DEMANDES. ANNEXER AU BESOIN DES FEUILLES SUPPLÉMENTAIRES.

TELEPHONE INQUIRIES MAY BE DIRECTED TO (506) 453-5676 POUR DE PLUS AMPLES RENSEIGNEMENTS, COMPOSER LE 506 453-5676.

SUBMIT A COMPLETED ORIGINAL APPLICATION TO: DEPARTMENT OF TRANSPORTATION AND INFRASTRUCTURE, P. O. BOX 6000, KINGS PLACE, FREDERICTON, NB E3B 5H1

PRÉSENTER L’ORIGINAL DÛMENT REMPLI AU : MINISTÈRE DES TRANSPORTS ET DE L’INFRASTRUCTURE, CASE POSTALE 6000, PLACE KING, FREDERICTON (N.-B.) E3B 5H1

AFTER RECEIPT OF YOUR APPLICATION, THE OFFICER RESPONSIBLE FOR THE PROGRAM MAY REQUEST ADDITIONAL INFORMATION.

APRÈS AVOIR REÇU LA DEMANDE, L’AGENT RESPONSABLE DU PROGRAMME POURRAIT DEMANDER D’AUTRES RENSEIGNEMENTS.

ALL INFORMATION PROVIDED WILL BE PROTECTED AGAINST UNAUTHORIZED ACCESS.

NULLE PERSONNE NON AUTORISÉE N’AURA ACCÈS AUX RENSEIGNEMENTS FOURNIS.

I have read and agree to be bound by the terms and conditions of this program. J’ai lu les modalités et conditions du programme et j’accepte de m’y conformer.

Signature of Applicant Signature du requérant _________________________________________________________________________

Date Date __________________________________

C. DOCUMENTS REQUIRED C. DOCUMENTATION

Please provide photocopy of: 1. Driver’s Licence2. Vehicle Registration3. Safety Inspection Form

Fournir une photocopie de : 1. Permis de conduire2. Immatriculation du véhicule3. Formule d’inspection de sécurité

Attach original cost estimates from two vendors. Annexer deux estimations originales de deux vendeurs.

THIS FORM TO BE SUBMITTED WITH THE VEHICLE RETROFIT APPLICATION FORM BY INDIVIDUALS APPLYING FOR A GRANT. FAILURE TO DO SO WILL RESULT IN A DELAY IN PROCESSING THE APPLICATION.

LA PERSONNE QUI FAIT UNE DEMANDE DE SUBVENTION DOIT ANNEXER LA PRÉSENTE FORMULE À LA DEMANDE AU PROGRAMME DES VÉHICULES ADAPTÉS. AUTREMENT, LE TRAITEMENT DE LA DEMANDE RISQUE D’ÊTRE RETARDÉ.

SIGNATURES REQUIRED:

1. Applicant (disabled person or guardian) 2. Occupational Therapist (or Physician, if Occupational Therapist not

available)

SIGNATURES REQUISES :

1. Requérant (personne handicapée ou tuteur) 2. Ergothérapeute (ou médecin s’il n’est pas possible d’obtenir la signature

d’un ergothérapeute)

Name of Disabled Person Nom de la personne handicapée ____________________________________________________________________________________________________________ Address Adresse _______________________________________________________________________________________________________________________________ Postal Code __________________________________________________________________________________________ Code postal Date Signature of Disabled Person or Guardian Date ______________________________ Signature de la personne handicapée ou du tuteur _________________________________________________________

PROOF OF DISABILITY Briefly describe medical condition.

PREUVE DU HANDICAP Décrivez brièvement l’état physique du requérant.

ACCESSIBLE FEATURES REQUIRED (list). ÉNUMÉREZ LES AUTRES DISPOSITIFS D’ACCESSIBILITÉ REQUIS.

OCCUPATIONAL THERAPIST OR PHYSICIANS CERTIFICATE I, the undersigned, licensed to practice, affirm that the applicant is known to me to have a disabling condition (described above), that would require the above-noted accessible features on his/her vehicle to enable the applicant to operate a vehicle as a driver or enable the applicant to be a passenger in a vehicle.

ATTESTATION DE L’ERGOTHÉRAPEUTE OU DU MÉDECIN Je soussigné, autorisé à exercer ma profession, affirme que le demandeur susmentionné a le handicap invalidant décrit ci-dessus. Pour pouvoir conduire un véhicule ou l’occuper comme passager, le demandeur doit posséder un véhicule équipé des autres dispositifs d’accessibilité énumérés ci-dessus.

Date / Date

Name (PRINT) / Nom (CARACTÈRES D’IMPRIMERIE)

Signature / Signature

Telephone / Téléphone

O.T. M.D. x O.T.

M.D.

Transportation Services for Persons with Disabilities and Seniors and P a g e | 6 4 Vehicle Retrofit Programs Appendix G SUPPLIERS OF ADAPTIVE EQUIPMENT FOR VEHICLES

It is recommended that you consult a qualified professional (i.e. an Occupational Therapist) in your region to assist in selecting the most appropriate equipment for your needs. Moncton Area Malley Industries Website: www.malleyindustries.com 1100 Aviation Avenue Dieppe, NB E1A 9A3

Telephone: (506) 859-8591

Toll-free: (877) 859-8591 Fax: (506) 857-1745

Products: Van conversions, lifts, left foot gas pedals, hand controls, tie-down and docking systems Harding Medical Website: www.hardingmedical.com 24 Elmwood Drive Moncton, NB E1A 3W6

Telephone: (506) 855-5200

Toll-free: (800) 479-4700 Fax: (506) 855-5113

Products: Portable ramps, wheelchair lifts, foot pedals, hand controls, seats, tie-down and docking systems Shoppers Home Health Care 535 Edinburgh Drive Moncton, NB E1E 4E3


Fax: (506) 388-6095 Email :

[email protected] Products : Hand controls, portable ramps, mobility lifts, power seats, van conversions

This list is provided as a guide and is NOT an endorsement of those suppliers identified.


Transportation Services for Persons with Disabilities and Seniors and P a g e | 6 5 Vehicle Retrofit Programs Lawtons Home Health Care 800 Mountain Road Moncton, NB E1C 2R4


Email: [email protected] Products: modifications, seats, controls, restraints and others. Call for information. Saint John Area MEDIchair/AML Website: www.medichair.com 381 Somerset Street Saint John, NB E2K 2Y5

Telephone: (506) 634-7488

Toll-free: (800) 663-7488 Fax: (506) 634-7404

Products: Chair topper, lifts, hand controls, VMI vans Harding Medical Supplies Website: www.hardingmedical.com 12 Bayside Drive Saint John, NB E2J 1A2

Telephone: (506) 633-5097

Fax: (506) 633-7278

Products: Portable ramps, lifts, hand controls, foot pedals, seats, tie-down and docking systems Lawtons Home Health Care 107 Catherwood Drive Saint John, NB E2M 5J7

Telephone: (506) 657-8547 Fax: (506) 633-8081

Email: [email protected] Products: modifications, seats, controls, restraints and others. Call for information. Fredericton area Howell Ventures Ltd. Website: www.suregrip-hvl.com 4850 Route 102 Upper Kingslcear, NB E3E 1P8

Telephone: (506) 363-5289

Toll-free: (888) 370-5050 Fax: (506) 363-2391

Toll-free: (888) 506-6666 Products: Hand controls, foot pedals


Transportation Services for Persons with Disabilities and Seniors and P a g e | 6 6 Vehicle Retrofit Programs MEDIchair/AML 180 Hodgson Road Fredericton, NB E3C 2G4


Fax: (506) 452-7449 Products: Lifts, chair topper, hand controls, vans Lawtons Home Health Care 5 - 435 Brookside Drive Fredericton, NB E3A 8V4

Telephone: (506) 292-3819 Email: [email protected]

Products: modifications, seats, controls, restraints and others. Call for information. Nova Scotia Lawtons Home Health Care 100 Isley Avenue, Unit Dartmouth, NB B3B 1L3

Telephone: (902) 480-3590 Fax: (902) 480-3480

Products: modifications, seats, controls, restraints and others. Call for information. Ontario Savaria Website: www.savaria.com/home/index.php 2 Walker Drive Brampton ON L6T 5E1

Telephone: (800) 661-5112 Telephone: (855) 728-2742

Fax: (514) 342-2600 Toll-free: (800) 361-1725

E-mail: [email protected] Products: Van conversions


Transportation Services for Persons with Disabilities and Seniors and P a g e | 6 7 Vehicle Retrofit Programs Québec Centre de l’auto St-Lambert Website: www.adaptsolutions.ca 145 Damase-Breton Street St-Lambert, QC G0S 2W0

Telephone: (418) 889-0419

Toll free : (866) 641-0419 Fax : (418) 889-9838

Email : [email protected] Products: Lifts, steering and custom modifications, power seats, electronic controls Eureka Solutions Website: www.eurekasolution.com 2755, Montée St-Hubert Longueuil, QC J3Y 4H6

Toll-free: (866) 562-2555

Fax: (450) 486-1488 Email: [email protected]

Products: Lifts, driving aids, restraints, lowered-floors, raised roofs Maine Autotronics/FND Inc. Website: www.autotronics.net/services/mobilitydivision.html Autotronics 129 US Route 1 Frenchville, ME 04745 PO Box 535 Madawaska, ME 04756

Telephone: (207) 543-6262

Fax: (207) 543-7412

69 Perry Road Bangor, ME 04401

Telephone: (207) 947-9897

Fax: (207) 947-6166 Products: vehicle retrofits


Transportation Services for Persons with Disabilities and Seniors and P a g e | 6 8 Vehicle Retrofit Programs Appendix H Easter Seal New Brunswick Application for Disability Travel Card


Disability Travel Card Application Form

DISABILITY TRAVEL CARDTM

APPLICATION FORM Easter Seals Canada and its members and/or affiliates are authorized to approve reduced fare tickets allowing persons with permanent disabilities to travel with an attendant* on the lines of Motor Coach Companies that participate in the reduced fare plan, and Via Rail. The Disability Travel Card™ provides identification to a person with a permanent disability, which will allow an adult attendant, travelling with the person with a disability, to travel at no cost. Reduced fares will be granted to the person with a permanent disability, unable to travel alone, (regardless of age) and accompanied by an adult attendant, if such person with a disability has received authorization from Easter Seals Canada or one of its designated affiliated members. Only persons with a permanent disability who require a support person when traveling can apply for the card. The applicant must agree to follow the Terms and Conditions for use of the card. * An attendant is an individual who accompanies a person with a permanent disability who cannot travel independently. An attendant will provide that person with required services that are not normally provided by a vehicle operator. These services include assisting the person with eating, administering medication and using the facilities in an on-board washroom or a washroom at a stop. The application for the Disability Travel Card™ must be verified by a Registered Health Care Provider (see Section B: Health Care Provider Information). The applicant must be a client/patient of the authorizing health care provider. Terms and Conditionsa) The person with a permanent disability and the adult attendant must travel together

for the entire trip. b) The adult attendant must be capable of assisting the person with a permanent

disability. c) The person with a disability will make application to Easter Seals Canada or its

designated affiliates by having completed the Application of Eligibility form. Upon approval of the Application of Eligibility by Easter Seals Canada or one of its designated affiliates an identification card will be issued authorizing the reduced fare.

NOTE: Ticket fares will be based on REGULAR FARES and are not applicable on any excursion fares, unlimited travel tickets or through to the United States. This card cannot be used in conjunction with clergy, Blind and Escort or other reduced fares or programs. Easter Seals Canada Page 1 of 5


Easter Seals Canada Page 2 of 5

BAGGAGE: Collapsible non-motorized wheelchairs and other aids will be accepted as Baggage. GENERAL INFORMATION TO NOTE:

The identification card must be returned to the issuing office and replaced with a new one if the eligible person changes his/her name or address

AIR TRAVEL: Contact the airlines directly regarding their reduced fare program

and criteria REDUCED BUS AND RAIL TRAVEL FARE A person with a disability accompanied by an adult attendant may travel for a reduced fare on any participating Canadian coach operators or Via Rail. The purpose of the reduced fare is to make it easier for people with disabilities to travel. It is not intended to restrict or hamper the travel of individuals with disabilities who do not require the services of an attendant. In offering to establish a reduced fare for people with disabilities Easter Seals Canada’s member agencies provide an Application and Disability Travel Card™ to those persons eligible. SECTION A: PERSONAL INFORMATION PLEASE PRINT Applicant’s Name: ________________________________________________ Address : ________________________________________________________ City: ________________ Province: ___________ Postal Code: __________ Telephone: ( )_________________________ Email: _______________ PRIVACY: Easter Seals Canada is committed to protecting the privacy, confidentiality, accuracy, and security of any personal information that we collect, use, retain, and disclose in the course of the services we offer. I hereby certify that I have read and understood all the terms and conditions as set forth in the application for the Disability Travel Card™ Card. Signature: ___________________ Date: ______________________


SECTION B: HEALTH CARE PROVIDER INFORMATION PLEASE PRINT Name of Authorized Health Care Provider: _______________________________ Registration Number (if applicable): ____________________________________ Address: _________________________________________________________ City: ________________ Province: _____________ Postal Code: __________ Telephone: ( )_________________________ Email: _______________ Does the applicant require an attendant* during travel? Yes No Please indicate category of Authorized Health Care Provider: Physician Nurse Social Worker Occupational Therapist Physiotherapist Pharmacist Rehabilitation Counsellor Audiologist Other (explain): _______________________________________________ Before signing below, please ensure that you have read the application form and are satisfied that the applicant fits within the parameters of the Disability Travel Card™ Program. PRIVACY: Easter Seals Canada is committed to protecting the privacy, confidentiality, accuracy, and security of any personal information that we collect, use, retain, and disclose in the course of the services we offer. I hereby certify that the applicant is a person with a disability in accordance with the provisions of the Disability Travel Card™ application and this applicant is a client/patient of mine. Signature: ___________________ Date: ______________________

Please return this application form to: Easter Seals New Brunswick

65 Brunswick Street Fredericton NB

E3B 1G5 Tel: 506 458 8739

Fax: 506 457 2863 web:www.easterseals.nb.caEaster Seals Canada Page 3 of 5