Confidential when completed.
Please keep a copy of the questionnaire for your records.
Collected under the authority of the Statistics Act, Revised Statutes of Canada, 1985, chapter S19. Completion of this questionnaire is a legal requirement under the Statistics Act.
Correct pre-printed information, if necessary.
Changes to corporate name or address:
Name
Street name and number
City
Province or Territory
Country
Postal code
Reporting period: January 1st to December 31st, 2011
Language preference
1. English
2. French
Please read before completing
Purpose of the survey
The purpose of this survey is to obtain information on the volume of refined petroleum products distributed by secondary distributors in Canada. It supplements energy consumption data collected from the refineries in the Annual Survey on End-Use of Refined Petroleum Products. The information collected by this survey provides all levels of governments and the private sector with a more accurate picture of the overall final demand for energy and helps to design energy and environmental policies. It also supports national and international reporting obligations.
Confidentiality
Statistics Canada is prohibited by law from releasing any information it collects which could identify any person, business, or organization, unless consent has been given by the respondent or as permitted by the Statistics Act. The confidentiality provisions of the Statistics Act are not affected by either the Access to Information Act or any other legislation. Therefore, for example, the Canada Revenue Agency cannot access identifiable survey records from Statistics Canada.
Information from this survey will be used for statistical purposes only and will be published in aggregate form only.
Data linkage
To enhance the data from this survey, Statistics Canada may combine it with information from other surveys or from administrative sources.
Data-sharing agreements
To reduce response burden and to ensure uniform statistics, Statistics Canada has entered into data-sharing agreements with provincial and territorial statistical agencies and other government organizations for the sharing of data from this survey. These organizations must keep the data confidential and use them only for statistical purposes. Statistics Canada will only share data from this survey with those organizations that have demonstrated a requirement to use the data.
Agreements to share information from this survey exist under Section 11 of the Statistics Act with the statistical agencies of Newfoundland and Labrador, Nova Scotia, New Brunswick, Quebec, Ontario, Manitoba, Saskatchewan, Alberta, British Columbia and the Yukon, regarding business establishments located or operating in their respective jurisdiction. These statistical agencies have the legislative authority to collect this information on their own or jointly with Statistics Canada. Their legislation also contains the same confidentiality protection and outlines similar penalties for disclosure of confidential information as the federal Statistics Act.
Agreements to share information from this survey exist under Section 12 of the Statistics Act with the statistical agencies of Prince Edward Island, the Northwest Territories and Nunavut, regarding business establishments located or operating in their respective jurisdiction, and with Environment Canada and Natural Resources Canada. Under Section 12, you may refuse to share your information with any of these organizations by writing a letter of objection to the Chief Statistician and returning it with the completed questionnaire. Please specify the organization with which you do not want to share your data.
Return of questionnaire
Please return the completed questionnaire to Statistics Canada within 30 days of receipt by mail, using the enclosed envelope or you can send it by fax at 1-888-883-7999.
Lost the return envelope or need help?
Call us at 1-866-445-4323 or mail to:
Statistics Canada, Operations and Integration Division,
Central Reception, SC0500 Main Building
150 Tunney’s Pasture Driveway
Ottawa, ON K1A 0T6
Fax or Other Electronic Transmission Disclosure
Statistics Canada advises you that there could be a risk of disclosure during the facsimile or other electronic transmission. However, upon receipt, Statistics Canada will provide the guaranteed level of protection afforded all information collected under the authority of the Statistics Act.
Please refer to the reporting guide before completing this questionnaire.
Motor gasoline
Please report total number of litres.
If exact numbers of litres are not available, please provide your best estimates.
Section A – Distribution of litres of fuel sold by type of customers (including Biofuels) for N.L., P.E.I., N.S., N.B., Que., Ont., Man., Sask., Alta., B.C., Y.T., N.W.T. and Nvt.
(Please refer to reporting guide).
Please check if customer type received their motor gasoline blended with Biofuel
1. Total Number of Litres Used for Own Consumption
2. Total Number of Litres Sold (including biofuels)
3. Residential
4. Sales to Wholesalers and Dealers of Refined Petroleum Products
5. Gasoline Stations (total litres sold from your own gasoline stations and to those owned by others)
Transportation
6. Railway Transportation Companies and Support Activities
7. Road Transportation Companies and Support Activities (refer to reporting guide)
8. Marine Transportation - Canadian Marine Vessels
9. Marine Transportation - Foreign Marine Vessels
Manufacturers
10. Food Manufacturers
11. Paper Manufacturers
12. Iron and Steel Manufacturers
13. Aluminum and Non Ferrous Metals Manufacturing and Processing Companies
14. Cement Manufacturers
15. Petroleum and Coal Products Manufacturers
16. Chemical and Fertilizer Manufacturers
17. Other Manufacturers
Mining and oil and gas extraction
18. Iron Mines
19. Oil and Natural Gas Extraction and Support Activities
20. Other Mining and Support Activities
21. Forestry, Logging, Fishing and Support Activities
22. Farmers, Hunters, Trappers and Support Activities
23. Construction Companies and Related Activities (refer to reporting guide)
24. Public Administration
25. Electric Power Generation Companies
26. Other Commercial and Institutional Customers (excluding amounts reported in lines 3 to 25)
27. Total Number of Litres Sold (including biofuels): Sum of Lines 3 to 26 (line 27 must equal line 2)
Section B – Biofuel for N.L., P.E.I., N.S., N.B., Que., Ont., Man., Sask., Alta., B.C., Y.T., N.W.T. and Nvt. (Please complete if applicable and refer to reporting guide)
If you are blending ethanol or purchasing gasoline blended with ethanol please report below.
1.a. Total Number of Litres of Ethanol Sold (Blended by yourself)
1.b. Please indicate source(s) of Ethanol used; check all that apply.
Wheat, Corn, Other
2.a. Total Number of Litres of Ethanol Sold (Purchased blended)
2.b. Please indicate source(s) of Ethanol used; check all that apply.
Wheat, Corn, Other
Diesel fuel oil
Please report total number of litres.
If exact numbers of litres are not available, please provide your best estimates.
Section A – Distribution of litres of fuel sold by type of customers (including Biofuels) for N.L., P.E.I., N.S., N.B., Que., Ont., Man., Sask., Alta., B.C., Y.T., N.W.T. and Nvt.
(Please refer to reporting guide).
Please check if customer type received their diesel fuel blended with Biofuel
1. Total Number of Litres Used for Own Consumption
2. Total Number of Litres Sold (including biofuels)
3. Residential
4. Sales to Wholesalers and Dealers of Refined Petroleum Products
5. Gasoline Stations (total litres sold from your own gasoline stations and to those owned by others)
Transportation
6. Railway Transportation Companies and Support Activities
7. Road Transportation Companies and Support Activities (refer to reporting guide)
8. Marine Transportation - Canadian Marine Vessels
9. Marine Transportation - Foreign Marine Vessels
Manufacturers
10. Food Manufacturers
11. Paper Manufacturers
12. Iron and Steel Manufacturers
13. Aluminum and Non Ferrous Metals Manufacturing and Processing Companies
14. Cement Manufacturers
15. Petroleum and Coal Products Manufacturers
16. Chemical and Fertilizer Manufacturers
17. Other Manufacturers
Mining and oil and gas extraction
18. Iron Mines
19. Oil and Natural Gas Extraction and Support Activities
20. Other Mining and Support Activities
21. Forestry, Logging, Fishing and Support Activities
22. Farmers, Hunters, Trappers and Support Activities
23. Construction Companies and Related Activities (refer to reporting guide)
24. Public Administration
25. Electric Power Generation Companies
26. Other Commercial and Institutional Customers (excluding amounts reported in lines 3 to 25)
27. Total Number of Litres Sold (including biofuels): Sum of Lines 3 to 26 (line 27 must equal line 2)
Section B – Biofuel for N.L., P.E.I., N.S., N.B., Que., Ont., Man., Sask., Alta., B.C., Y.T., N.W.T. and Nvt. (Please complete if applicable and refer to reporting guide)
If you are blending Biodiesel to your Diesel Fuel Oil, please report below.
1. Total Number of Litres of Biodiesel Sold
2. Please indicate source(s) of Biodiesel used; check all that apply.
Animal: Tallow, Fish Oil, Chicken Fat
Vegetable: Soya Palm Oil, Canola, Yellow Grease
Other
Heating fuel oil
Please report total number of litres.
If exact numbers of litres are not available, please provide your best estimates.
Section A – Distribution of litres of fuel sold by type of customers (including Biofuels) for N.L., P.E.I., N.S., N.B., Que., Ont., Man., Sask., Alta., B.C., Y.T., N.W.T. and Nvt.
(Please refer to reporting guide).
Please check if customer type received their heating fuel oil blended with Biofuel
1. Total Number of Litres Used for Own Consumption
2. Total Number of Litres Sold (including biofuels)
3. Residential
4. Sales to Wholesalers and Dealers of Refined Petroleum Products
5. Gasoline Stations (total litres sold from your own gasoline stations and to those owned by others)
Transportation
6. Railway Transportation Companies and Support Activities
7. Road Transportation Companies and Support Activities (refer to reporting guide)
8. Marine Transportation - Canadian Marine Vessels
9. Marine Transportation - Foreign Marine Vessels
Manufacturers
10. Food Manufacturers
11. Paper Manufacturers
12. Iron and Steel Manufacturers
13. Aluminum and Non Ferrous Metals Manufacturing and Processing Companies
14. Cement Manufacturers
15. Petroleum and Coal Products Manufacturers
16. Chemical and Fertilizer Manufacturers
17. Other Manufacturers
Mining and oil and gas extraction
18. Iron Mines
19. Oil and Natural Gas Extraction and Support Activities
20. Other Mining and Support Activities
21. Forestry, Logging, Fishing and Support Activities
22. Farmers, Hunters, Trappers and Support Activities
23. Construction Companies and Related Activities (refer to reporting guide)
24. Public Administration
25. Electric Power Generation Companies
26. Other Commercial and Institutional Customers (excluding amounts reported in lines 3 to 25)
27. Total Number of Litres Sold (including biofuels): Sum of Lines 3 to 26 (line 27 must equal line 2)
Section B – Biofuel for N.L., P.E.I., N.S., N.B., Que., Ont., Man., Sask., Alta., B.C., Y.T., N.W.T. and Nvt. (Please complete if applicable and refer to reporting guide)
If you are blending Biodiesel to your Heating Fuel Oil, please report below.
1. Total Number of Litres of Biodiesel Sold
2. Please indicate source(s) of Biodiesel used; check all that apply.
Animal: Tallow, Fish Oil, Chicken Fat
Vegetable: Soya Palm Oil, Canola, Yellow Grease
Other
Heavy fuel oil
Please report total number of litres.
If exact numbers of litres are not available, please provide your best estimates.
Section A – Distribution of litres of fuel sold by type of customers for N.L., P.E.I., N.S., N.B., Que., Ont., Man., Sask., Alta., B.C., Y.T., N.W.T. and Nvt.
(Please refer to reporting guide).
1. Total Number of Litres Used for Own Consumption
2. Total Number of Litres Sold
3. Residential
4. Sales to Wholesalers and Dealers of Refined Petroleum Products
5. Gasoline Stations (total litres sold from your own gasoline stations and to those owned by others)
Transportation
6. Railway Transportation Companies and Support Activities
7. Road Transportation Companies and Support Activities (refer to reporting guide)
8. Marine Transportation - Canadian Marine Vessels
9. Marine Transportation - Foreign Marine Vessels
Manufacturers
10. Food Manufacturers
11. Paper Manufacturers
12. Iron and Steel Manufacturers
13. Aluminum and Non Ferrous Metals Manufacturing and Processing Companies
14. Cement Manufacturers
15. Petroleum and Coal Products Manufacturers
16. Chemical and Fertilizer Manufacturers
17. Other Manufacturers
Mining and oil and gas extraction
18. Iron Mines
19. Oil and Natural Gas Extraction and Support Activities
20. Other Mining and Support Activities
21. Forestry, Logging, Fishing and Support Activities
22. Farmers, Hunters, Trappers and Support Activities
23. Construction Companies and Related Activities (refer to reporting guide)
24. Public Administration
25. Electric Power Generation Companies
26. Other Commercial and Institutional Customers (excluding amounts reported in lines 3 to 25)
27. Total Number of Litres Sold: Sum of Lines 3 to 26 (line 27 must equal line 2)
Administration
How long did you spend collecting the data and completing the questionnaire?
Hour(s)
Certification
Name of signer
First Name (please print)
Last Name (please print)
Signature
Official title of signer
Name of person to be contacted in connection with this report
First Name (please print)
Last Name (please print)
Telephone
Extension
Date (yyyy-mm-dd)
E-mail
Facsimile
Reporting guide feedback
Did you refer to the Reporting Guide?
Yes
No
If yes, please provide any comments that would help us to improve the Reporting Guide.
Other comments
We invite your comments below. Please be assured that we review all comments with the intent of improving the survey.
Thank you for completing this questionnaire.
Please keep a copy for your records.
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