Fillable Service Works Request for a new connection or (Australian National University)

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Service Works Request for a new connection or (Australian National University)

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The Service Works Request for a new connection or (Australian National University) form is 2 pages long and contains:

  • 0 signatures
  • 18 check-boxes
  • 57 other fields

Country of origin: AUSTRALIA
File type: PDF

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First name: Last name:
Mobile: Alternative Phone Number:
Electrical Lic. No:
Business name:Email:
ABN:
Service Works Request for a
new connection or alteration
(Electricity)
Please complete all applicable sections of the form in block
letters and tick any boxes relevant to your application . It will
be helpful if the electrician and the account holder work
together to complete this form. If your form is incomplete,
your application may be delayed.
Use this form to apply for:
• Installation of a new electricity supply/meter
• Alteration of your existing electricity supply/meter
• NSW, ACT and SA customers only
If your application is for a new meter, please email your
completed form to: ncpaperwork@energyaustralia.com.au
If your application is for an alteration, please email your
completed form to: elecalterations@energyaustralia.com.au
Alternatively, you can send your form to us via:
Post: EnergyAustralia Electricity New Connections
Locked Bag 14060, Melbourne City MC VIC 8001
Fax: 1800 654 295
If you have any questions, or need help with your application,
please call us on 1800 818 378 (Monday to Friday, 8am-5pm AEST)
and we’ll be happy to help.
1. What type of service do you need?
Metering alterations - Please specify details on right
Supply alterations - Please specify details on right
New Connections
3. Site address
4. Connection details
Lot no: Unit no: Street no:
Street name:
CT installed/required:
O peak load requirements:
Maximum demand of installation: Maximum demand of total site: REX ID (SA customers only):
Solar/embedded generation:
PV SEG approval number (SA solar customers only):
Suburb: State:
Amps per phase Amps per phase
Postcode:
Plan of sub-division no:
Electricity meter ID
(mandatory for alterations):
DP no. (NSW Endeavour
and Essentials customer only):
NMI (new connections
NSW Ausgrid customers only):
Connection type:
Permanent
Temporary
Supply phase:
1 Phase
2 Phase
3 Phase
Meter phase:
1 Phase
3 Phase
2 Phase
Installation type:
Overhead
Overhead and Underground
Underground
Premises type:
Residential
Commercial
NoYes
If Yes, please specify:No
NoYes
5. Electrical contractor details
2. Description of works
First name: Last name:
Mobile:
Electrical Lic. No:
6. Level 2 - Accredited service provider (NSW customers only)
Vector AMS accredited:
NoYes
7. Account holder details
Title: First name: Last name:
Unit no: Street no: Street name:
Alternative phone number: Email:
Business name (if applicable):
Date of birth: Expiry Date:
Driver’s licence or
Medicare number:
Issuing State:
Suburb:
State: Postcode:
Mobile:
ABN:
Mailing address
8. To be completed by the account holder
Please indicate your acceptance by signing below.
Please note: If the premises are leased, please include a letter of permission from the owner/landlord with your application.
Installations only
I authorise EnergyAustralia to arrange for the distributor and/or metering service provider to install the electricity supply/meter at the address, provided in this application,
on the date the request is accepted or as soon as can be arranged. I understand that the installation is subject to weather conditions and clear and safe access to the site,
including the switchboard (the site must be clean, free from safety hazards and debris and have clear address numbering) and the meter board must not be defective
or otherwise unsafe. I understand that charges apply to the new connection (including if I am unable to provide clear and safe access) and they can vary depending on
the works required. I agree to accept any charges associated with the installation and understand these charges will appear on my electricity bill. I understand that if the
technician determines additional works are needed they will not commence the job and EnergyAustralia will contact me to discuss any additional charges and/or work
required.
I authorise EnergyAustralia to contact me so that an electricity account can be set up in my name.
Alterations only
I authorise EnergyAustralia to arrange for the distributor and/or metering service provider to alter the meter and/or supply at the address provided in this application, on
the date the request is accepted or as soon as can be arranged. I understand that the alteration work is subject to weather conditions and clear and safe access to the
site, including the switchboard (the site must be clean, free from safety hazards and debris and have clear address numbering) and the meter board must not be defective
or otherwise unsafe. I understand that charges may apply to the alteration (including if I am unable to provide clear and safe access) and they can vary depending on
the works required. I agree to accept any charges associated with the alteration and understand these charges will appear on my electricity bill. I understand that if the
technician determines additional works are needed they will not commence the job and EnergyAustralia will contact me to discuss any additional charges and/or work
required.
I authorise EnergyAustralia to contact me to set me up on a compatible plan if required.
Information about our privacy policy
EnergyAustralia collects information for the purposes of providing the services related to your electricity supply at the site address. In order to provide the services, we will
disclose this information to the metering service provider and/or electricity distributor in accordance with our privacy policy which can be found at energyaustralia.com.au/
privacy.
Date:
Signature of applicant
EnergyAustralia Pty Ltd ABN 99 086 014 968
Locked Bag 14060
Melbourne VIC 8001
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Service Works Request for a new connection or (Australian National University)

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Completed 21 June 2022

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