Energy Resilience Community Fund application

l attest that I am the residential electricity account holder (Applicant), or I am an authorised representative of the Applicant and have approval to make this application.

I agree and declare that:

• The Applicant has read, understands and agrees to be bound by the program guidelines.
• The Applicant satisfies the eligible criteria for the Energy Resilience Community Fund payment.
• The Applicant is applying for the Energy Resilience Community Fund payment.
• All information disclosed to support this application for the Energy Resilience Community Fund payment is true, complete, accurate and not misleading.
• The Applicant will notify AusNet of any changes to this information and any circumstances that may affect this application.
• This application for an Energy Resilience Community Fund payment may be rejected or cancelled, or if payment has already been made, reimbursement may be sought from the Applicant.
• The Applicant has not received a prolonged power outage payment for the electricity account (NMI) nominated in this application.

I understand and agree that personal details provided are collected and used for the purposes of confirming eligibility for payment and to support assurance and auditing activities. I understand that personal information will be managed in accordance with the AusNet Privacy Policy.