Please fill out and submit the form below:

This dwelling has been examined by a qualified energy advisor based on the NRCan residential energy assessment protocol's standard operating conditions. The report represents the advisor's best judgement given the information and time available. The purpose of the evaluation is to assess the energy efficiency of the dwelling; it is not meant to replace a full house inspection. NRCan makes no warranty, expressed or implied, with respect to the energy consumption figures, cost estimates or energy efficiency recommendations included in this assessment. Actual energy consumption and costs depend on a host of factors beyond the control of NRCan.

I certify that - I am the owner of the above-noted property. - I assume all responsibility for the selection of products and services used in these renovations, and for obtaining all applicable permits and paying all applicable taxes on work performed. - I understand that NRCan does not endorse the services of any contractor or any specific product and accepts no liability in the selection of materials, products, contractors or performance or workmanship. - I understand I am responsible for verifying the eligibility criteria for any program associated with the energy assessment. The data collected in the electronic file will be provided to NRCan for the purpose of statistical analysis and quality assurance. Personal information on this form is being collected in order to confirm property ownership and address. Personal information will be protected under the Privacy Act

In the event that another federal department, provincial/territorial or municipal government, or a utility company that has an agreement with NRCan offers a homeowner benefit based on the NRCan assessment, I authorize NRCan to provide my personal information directly to this party.