Compensation claim form

Power outages due to storm events and other natural disasters are not claimable from us and are also excluded from our Guaranteed Service Levels.

If you hold a current household insurance policy, your insurer may consider your claim for damages. Please enquire directly with them for further information.

Submissions will be considered by us and a response will be given to each respondent on the issues raised.

If the item is damaged beyond economical repair, the claim will be settled by:

Replacement with a current market equivalent item
Reimbursement for its depreciated value dependent on the age of the item.

Please Note: Fields marked with * must be completed.

Title:

First name: *

Surname: *

Are you GST Registered? *

Name of business (if applicable):

ABN

Electricity account details:

Premises type

National Metering Identifier (NMI) Your NMI is 10 or 11 digits with no spaces and can be found on your electricity bill.

Postal address:

Suburb:

Postcode:

Contact phone number:

Mobile phone number:

Email:

Re-enter your email address: *

Please enter the approximate time and date of the incident:

Time of the incident:

Hour Minute

Date of incident:

Day Month Year

Did you lose power?

If yes, how long were you without power?

Location of where the incident occurred:

Street address:

Suburb:

Postcode:

Have you advised your insurance company of this incident?

Please describe how the loss or damage occurred:

Enter the details of item(s) or property being claimed. If more fields are required, please send a separate email to claims@energex.com.au.

Item 1

Type of item:

Item age:

Make:

Model:

Details: *

Item 2

Type of item:

Item age:

Make:

Model:

Details:

Item 3

Type of item:

Item age:

Make:

Model:

Details:

Item 4

Type of item:

Item age:

Make:

Model:

Details:

Item 5

Type of item:

Item age:

Make:

Model:

Details:

Item 6

Type of item:

Item age:

Make:

Model:

Details:

Item 7

Type of item:

Item age:

Make:

Model:

Details:

If your claim is not for an electrical item, please provide a description of what you are claiming for: Is a repairer's report available for item(s) being claimed? If yes, please scan and email to claims@energex.com.au or fax to (07) 3025 8301. Has the item been repaired? If yes, please scan and email to claims@energex.com.au or fax to (07) 3025 8301.

The completion of this form does not constitute an admission of liability on the part of Energex.

Regarding your privacy

Energex is collecting personal information on this form for the purpose of processing your claim. By completing this form, you consent and agree to Energex collecting, managing and disclosing the personal information you have provided to us in accordance with our Privacy Statement. Our Privacy Statement and contact details are available at energex.com.au

By completing this form you acknowledge that:

The information given on this application form is complete and correct.
You are the owner of all the lost or damaged property identified in this claim request.
You will provide Energex assessors with reasonable access to investigate your claim request.
Any goods (excluding food) included in your claim request will not be disposed of without the prior consent of Energex.