Network outage information request form

Please complete the form below to request a confirmation letter for a power outage at your property.

Title:

First name: *

Surname:

Street address:

Suburb:

Postcode:

Contact phone number:

Mobile phone number:

Email:

Please enter the approximate time and date of the incident:

Time of the incident:

Hour Minute

Date of incident:

Day Month Year

Did outage last for more than a few seconds?

Please enter postal address if different to the address where the incident occurred:

Postal street address:

Suburb:

Post Code:

Outage details:

Please include any additional details relating to the power outage:

Please note: Fields denoted with * are mandatory.

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