Certification for change in zero rating status Step 1 of 3 33% This form should be completed by registered providers that have previously certified as eligible for zero-rating but that now consider they could give rise to an eligible complaint and therefore are no longer eligible. For example, this might be if the entity now provides financial services to eligible complainants, such as individuals, small businesses or certain local charities. For more information see the Explanatory Notes for Financial Services Providers. If you require assistance, please contact CIFO with your question at billing@CI-FO.org. How to Complete the Certification Once you have completed the form you will have an opportunity to review the document before certifying and submitting. You may wish to save or print a copy for your own records. Name of Entity* Name of person providing this certification* Job title* Contact phone number* Contact Email Address* Please complete the following statement : I certify that this entity is liable for the levy as it could give rise to eligible complaints and is therefore no longer eligible for zero-rating.*Please complete the following statement : I certify that this entity is liable for the levy as it could give rise to eligible complaints and is therefore no longer eligible for zero-rating. Yes Date that this change in status became effective:* DD slash MM slash YYYY Submission Date Please review your submission below: {all_fields}