How to lodge your Claim

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Owner Tenant

Title

First Name*

Last Name*

Business Name (if applicable)

ABN Number

Customer Type*

Address of Property (Where incident occurred)*

Suburb*

State*

Post Code*

Mailing address (if not the same as above)

Suburb

State

Post Code

Contact number*

Secondary contact number

Email address* I don’t have an email address

NMI number (Electricity Claims Only - Find this on your bill) Help

MIRN number (Gas Claims only - Find this on your bill) Help

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Date of incident (approximate if unknown)*

Circumstances causing damage/loss (Describe what happened) *

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DETAILS OF DAMAGE:

PLEASE DO NOT DISPOSE OF ANY DAMAGED APPLIANCES until such time as your claim has been assessed as inspection may be required.
Failure to include all supporting documentation will cause delay in the processing of your claim.
If your Claim Form is incomplete, or the required supporting quotes, invoices or receipts are not attached, your claim will be delayed.
AusNet Services does not have its own repairers. It is your responsibility to arrange for quotes or obtain repairer receipts for any work undertaken by a qualified technical expert.
If a damaged item can be repaired, but you have not yet arranged repairs, please provide the written quote. The repairer should state what caused the damage to the appliance(s).
Where AusNet Services can demonstrate that the cost of repairs was excessive, we reserve the right to reimburse reasonable repair costs, not actual costs.
Please provide details and attach the supporting quotes, invoices or receipts for each item of your claim below.

Attachments must be less than 5MB and the total of all attachments cannot exceed 30MB. The larger the size the longer it will take to submit your claim.
You can submit the following file types only: jpg, jpeg, png, gif, bmp, doc, docx, txt, pdf, xls, xlsx, xlt, ppt, pptx and zip.

#	Claimed Item*	Make	Model No.	Age (years)	Quote/ Invoice/ Report	Amount Claimed*

* Should you have difficulties with submitting your documents, you will be able to email them to us by replying to the confirmation email you will receive.

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Declaration

All information provided and statements made are truthful and accurate and no information likely to affect the outcome of this claim has been withheld.
I/We acknowledge that AusNet Services will rely upon information supplied by me/us when determining this claim.
The damaged equipment/appliance which is the subject of this claim is owned by me/us
Neither I, nor any person claiming on my behalf, have made a claim for this damage to anyone else (including an insurer), nor will I make such a claim, if I accept any payment or other benefit from AusNet Services in settlement of this claim.

Full name of Claimant*

I acknowledge the declaration above*

Privacy Declaration
Personal details provided are collected and used for the purposes of managing customer claims on the AusNet Services electricity and gas distributions networks. The information provided will be treated as confidential and only disclosed to our employees and agents to allow processing of your claim. If you wish to gain access to the information you have provided, please contact us on our claim enquiry numbers listed below.