Confidential when completed.
Please keep a copy of the questionnaire for your records.
This information is collected under the authority of the Statistics Act, Revised Statutes of Canada, 1985, chapter S-19.
COMPLETION OF THIS QUESTIONNAIRE IS A LEGAL REQUIREMENT UNDER THIS 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, 2012
Language preference
1. English
2. French
Please read before completing
Survey Purpose
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. Your information may also be used by Statistics Canada for other statistical and research purposes.
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. Statistics Canada will use the information from this survey for statistical purposes.
Record linkages
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 respondent burden, Statistics Canada has entered into data-sharing agreements with provincial and territorial statistical agencies and other government organizations, which have agreed to 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.
Section 11 of the Statistics Act provides for the sharing of information with provincial and territorial statistical agencies that meet certain conditions. These agencies must have the legislative authority to collect the same information, on a mandatory basis, and the legislation must provide substantially the same provisions for confidentiality and penalties for disclosure of confidential information as the Statistics Act. Because these agencies have the legal authority to compel businesses to provide the same information, consent is not requested and businesses may not object to the sharing of the data.
For this survey, there are Section 11 agreements with the provincial and territorial statistical agencies of Newfoundland and Labrador, Nova Scotia, New Brunswick, Quebec, Ontario, Manitoba, Saskatchewan, Alberta, British Columbia and the Yukon.
The shared data will be limited to information pertaining to business establishments located within the jurisdiction of the respective province or territory.
Section 12 of the Statistics Act provides for the sharing of information with the federal, provincial or territorial government organizations. 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 organizations with which you do not want to share your data.
For this survey, there are Section 12 agreements with the statistical agencies of Prince Edward Island, Northwest Territories and Nunavut as well as with Environment Canada and Natural Resources Canada.
For agreements with provincial and territorial government organizations, the shared data will be limited to information pertaining to business establishments located within the jurisdiction of the respective province or territory.
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 E-Mail Transmission Disclosure
Statistics Canada advises you that there could be a risk of disclosure during the transmission of information by facsimile or e-mail. However, upon receipt, Statistics Canada will provide the guaranteed level of protection afforded to all information collected under the authority of the Statistics Act. Note: There is no risk of disclosure if you are completing a web-based questionnaire online.
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.
Visit our website at www.statcan.gc.ca