Gas Supply Disconnection Form
For Office Use Only – Job Reference Number
1. Job Details
Job Address
Correspondence Address
Contact Name
Contact Name
Address
Organisation
If Different to Job Address
Address
Postcode
Postcode
Telephone (Day)
Telephone (Day)
Mobile
Telephone (Evening)
Fax
Mobile
Email
Fax
Site contact
Email
Telephone number
2. Details about this disconnection (Please tick circles where appropriate)
Is this a single or multiple disconnection?
Single l
Multiple l
If this is a multiple disconnection, please give details of the addresses and number of properties
(Use separate sheet if necessary)
SGN_038N_12/10
Meter Point Reference Number (MPRN) number(s) if known – this can be found on your gas bill.
Please note we require your MPRN number. If this information is not provided, your request may be delayed.
If you proceed with the quotation for a disconnection you will need to contact your gas supplier. If you do not
know who your gas supplier is, please contact 0870 608 1524. If you request the disconnection of the gas
supply to your property then you must make sure that the meter has been removed prior to the disconnection
being carried out. Failure to do so could result in abortive visit charges and work not being carried out on the
date requested. This disconnection is permanent. Any reconnection would be treated as a new supply request.
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SGN Connections Limited is part of the Scotia Gas Networks group registered in England No. 5618886
Registered Office: St. Lawrence House, Station Approach, Horley, Surrey RH6 9HJ Web: www.sgn.co.uk
3. Please give the reason for your request – e.g. demolition, gas no longer required etc.
This information will help us to process your request.
4. Please give an indication of when the disconnection will be required
5. Please give us any other information which you feel may be relevant (or provide us with a
map if possible indicating the site)
Do you wish to receive your quotation via email?
Yes l
No l
I certify that the information given is correct to the best of my knowledge.
Signature:
Print Name:
Date:
Please return completed application form to the address listed below:
Commercial disconnections and multiple
properties in Scotland:
Axis House
5 Lonehead Drive
Newbridge, Edinburgh
EH28 8TG
For all other disconnections:
St. Lawrence House,
Station Approach,
Horley, Surrey,
RH6 9HJ
If you have any queries with this form please contact our Customer Service Centre on 0845 070 1431
(Southern customers) and 0845 070 1432 (Scotland customers) or email sgnconnections@sgn.co.uk
Please note that SGN Connections Limited is acting as the agent of Scotland Gas Networks plc and Southern
Gas Networks plc and your contract will be with Scotland Gas Networks plc (if the works are being carried out in
Scotland) or Southern Gas Networks plc (if the works are being carried out in England) in accordance with the terms
and conditions attached to this application form.
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SGN Connections Limited is part of the Scotia Gas Networks group registered in England No. 5618886
Registered Office: St. Lawrence House, Station Approach, Horley, Surrey RH6 9HJ Web: www.sgn.co.uk