Service Works Request Form

Please complete the details in the table below for to process your work request. We strongly encourage you have this application completed by your electrician.

Please note: NSW: Site Address Lot & DP number are a Mandatory Requirement for New Connections in the and Distribution zones. All States: Abolishment requests are only required to complete sections in Green.

Work Request Type New Please Circle/Highlight Alteration Abolishment Connection Customer Details

Customer Name

Best Contact Number

Mobile Preferred

Postal Address

Customer e-mail

Premises Details Street Address Include Lot Number, & DP number if known

Access Instructions

If applicable

Suburb & Post Code

Premises Type

(Residential/Commercial/Other)

NMI MANDATORY for New Connections. Connection Details Connection Type Supply Phase

(Temporary/Permanent) (1,2,3 or Other) Maximum Maximum Demand of Demand of total installation Site (Amps p/Phase) (Amps p/Phase)

CT’s Solar/Embedde Installed/Required? d Generation? (Yes/No) (Yes/No) Installation Type Off-Peak Load (Overhead, Requirements

Underground, Overhead If applicable. List to Underground) appliances REX ID – SA Only PV SEG – (MANDATORY for SA SA SOLAR Only Supply Alterations) (PV Seg. number) Existing Supply Details Description of Works Is this request in conjunction with other works? If Abolishment, please include date property is vacant from.

Meter ID

New Meter Phase

If applicable New Supply Phase

If applicable Electrical Contractor Details / Solar Installer Details

ID/License Number

Electrical Contractor Name

Best Contact Number

Mobile Preferred

E-mail address

- NSW Supply Alterations & New Connections Only -

L2 ASP Name

Best Contact Number

Mobile Preferred L2 ASP License VectorAMS Accredited

Number Yes / No

Please send your completed form to us via: Email: ncpaperwork@.com.au (Non-Solar) Email: [email protected] (Solar Requests) Post: EnergyAustralia New Connections, Locked Bag 14060, City MC, VIC 8001, Australia Fax: 1800 654 295 If you have any questions, or need help with your application, please call us on 1800 818 378 and we’ll be happy to help.