Service Works Request Form Please complete the details in the table below for Energy Australia 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 Endeavour Energy and Essential Energy 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 Ausgrid 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: [email protected] (Non-Solar) Email: [email protected] (Solar Requests) Post: EnergyAustralia Electricity New Connections, Locked Bag 14060, Melbourne 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. .