Claim Form Information
As requested, enclosed is our claim form for loss or damage. Before you complete the claim form, please
carefully read all the information on the form.
Please note the following IMPORTANT information regarding your claim.
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We do NOT replace on a ‘NEW FOR OLD’ basis. Any settlement relating to damage to appliances or
equipment as a result of a voltage variation or gas supply issues, will be based on the item’s depreciated
value, or the reasonable cost to repair, whichever is the lesser amount
It may be to your advantage to contact your insurer, as they may offer coverage for your loss
We do not/cannot guarantee an uninterrupted supply of electricity or gas
You must provide all supporting documentation or we cannot process your claim
1. CLAIMS FOR POWER SURGE DAMAGE TO APPLIANCES / EQUIPMENT
To ensure that your claim is investigated/assessed as soon as possible, please provide:
• The original of your repair quotes/invoices
• Details of the make, model number and age of damaged item/s
• Original purchase receipt/proof of age of the appliance (if available)
• A written statement from your repairer confirming that the appliance has been inspected and that the
damage is consistent with a power surge
• If the item is “beyond economical repair” or otherwise unrepairable, this is to be stated by the repairer
2. CLAIMS ARISING FROM LOSS OF ELECTRICITY SUPPLY
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All claims arising from supply interruption are subject to investigation to determine the cause of that
interruption. Supply loss is often due to external causes such as cars striking poles, storms, lightning,
animal or bird activity, and third party damage to assets, etc. Loss of supply in these cases is beyond
our control. Note: We do not guarantee an uninterrupted service
3. COMPUTER CLAIMS
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If you are claiming for damage to a computer, in addition to a quote/account for its repair, please also
provide the specifications of your damaged computer (i.e. CPU GHz, RAM, etc)
4. BUSINESS CUSTOMERS – Additional Information Required
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Business customers should note that the Essential Services Commission requires that businesses must
take reasonable precautions to minimise the risk of damage or loss to a business as a result of voltage
variations
Please provide details of electrical protection in place prior to the date of the incident to minimise the risk
of loss or damage to your business
If you have any further questions regarding your claim, please contact us on 1300 360 795 or email us at
customer.resolutions@ausnetservices.com.au
Who is AusNet Services?
AusNet Services, formerly SP AusNet, is an electricity and gas distribution company which owns, operates and
maintains electricity and gas networks to deliver electricity and gas to customers in Victoria’s east (electricity)
and west (gas).
Your retailer (TRU Energy, Origin, AGL etc) uses our assets to supply you with electricity or gas.
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Claims Office Use Only
Claim No.
Code No.
Fdr No.
Claim Form – Damage/Loss
The issue of this claim form is in no way to be construed
as an admission of liability by AusNet Services.
PLEASE MAKE SURE YOU HAVE READ THE COVERING LETTER
BEFORE COMPLETING THIS CLAIM FORM
Consider your claim options:
(a) Should any property be damaged beyond economical repair, you may wish to refer the claim to your
home and contents or business insurer who may be better placed to offer a higher level of compensation.
AusNet Services is not obliged to offer settlement on the basis of “new for old”. Should you require
a letter for insurance purposes, AusNet Services will issue an insurance letter, upon request.
(b) If you claim through your home and contents or business insurance policy, AusNet Services may consider
a contribution towards the insurance policy excess.
A. CUSTOMER INFORMATION
NMI Number (Electricity Claims Only)
MIRN Number (Gas Claims Only)
6305
533
(Please refer to your Electricity/Gas Account for the above requested details)
Name of Claimant
(Mr/Mrs/Ms)
OWNER
TENANT
3
Business Name (if applicable)
ABN Number
Type of Business
Address of Property (Where Incident Occured)
Post Code
Mailing Address (if not as above)
Post Code
Telephone (Home)
Telephone (Work)
(Mobile)
Email Address (Optional)
1
Please attach documents here
B. DAY AND DATE OF INCIDENT
TIME OF INCIDENT
am
pm
C. CIRCUMSTANCES CAUSING DAMAGE / LOSS (Describe what happened)
Please continue on another blank page if space is insufficient.
IMPORTANT NOTES
Please ensure you provide sufficient evidence to support your claim. Without supporting documentation,
AusNet Services will be unable to process your claim.
Please note that 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 trades
person. Maximum payment is the depreciated value of the goods or cost of repairs, whichever is
the lesser.
If a damaged item has been repaired, please provide the receipt from the repairer. The receipt should
state the details of the damaged good(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.
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).
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D. DETAILS OF DAMAGE
If you wish to have your original documentation returned please tick this box
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 original quotes / receipts are not attached,
your claim CANNOT be attended to. In these circumstances your Claim Form will be returned to
you for completion, or a letter will be sent requesting further documentation.
Type of Appliance
Make
Model No.
Age
(years)
Quote/
Invoice/
Report(s)
Attached
(yes/no)
Amount
Claimed
1
$
2
$
3
$
4
$
5
$
6
$
7
$
8
$
OTHER DAMAGE / LOSS
9
$
10
$
11
$
12
$
Please provide any other details relating to your claim
TOTAL AMOUNT CLAIMED $
PLEASE REFER TO PAGE 4 TO COMPLETE AND SIGN THE CLAIM FORM
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E. DECLARATION BY CLAIMANT
I/We state:
1) All information provided and statements made are truthful and accurate and no
information likely to affect the outcome of this claim has been withheld.
2) I/We acknowledge that AusNet Services will rely upon information supplied by me/us
when determining this claim.
3) The damaged equipment/appliance which is the subject of this claim is owned by me/us
4) 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
(please print - block letters)
Signature of Claimant
Date
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.
POWER SURGE CLAIMS
Please note that claims for damage resulting from “power surges” are managed in
accordance with the Voltage Variation Compensation Guidelines issued by the Essential
Services Commission.
These guidelines are available on our website - www.ausnetservices.com.au
F. SUBMISSION OF CLAIM
Send this claim form and your original documents as proof of damage to:
Customer Resolutions Manager
AusNet Services
Locked Bag 14051
Melbourne City Mail Centre 8001
Victoria
Enquiries: 1300 360 795
AN03139
0814
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