NSW Family Energy
NSW Department of Planning, Industry and Environment | July 2021 | 2
Application form: Retail customers
Applications close at 11pm on Thursday 30 June 2022.
If you have a Services Australia Concession Card or Health Care Card and meet all the
eligibility criteria for the Family Energy Rebate, your rebate credit will be approved at the lower
capped rate of $20 (for retail customers), as you also qualify for the NSW Low Income Household
Rebate. More information on the Low Income Household Rebate for retail customers is available
Visit the Service NSW website at: www.service.nsw.gov.au/services/concessions-rebates-and-
Call Service NSW: 137 788
The Department of Planning, Industry and Environment (the Department), located at 4 Parramatta
Square, 12 Darcy Street, Parramatta NSW 2150, is subject to the Privacy and Personal
Information Protection Act 1998 in managing your personal information.
The Department is collecting your personal information for the purposes of processing your
application for an energy rebate (including assessing your eligibility), paying a rebate to you if you
are eligible, administering the energy rebates scheme and auditing the rebate program which may
include surveying customer experiences.
In completing this form you may provide the personal information of another person. Before you
provide this information you must seek the consent of that person to disclose their information to
the Department and for it to be used in accordance with this Privacy Notice.
The Department will disclose your CRN or DVA number to Services Australia to determine whether
you qualify for the rebate. The Department may disclose your personal information to a third party
engaged to carry out an audit of the rebate. The Department will not disclose your personal
information to anybody else unless authorised by law.
Applying for this rebate is voluntary. However, if you decide to apply, unless otherwise noted, all
personal information requested directly from you must be provided for the Department to process
You have the right to access the personal information that the Department holds about you. You
also have the right to request that the Department updates or amends this information. For further
details, email: email@example.com.