Simply Energy - Forms Residential

Concession Consent Request

The account holder or secondary account holder is eligible to apply.

First name *

Surname *

Telephone Number *

Street Address *

Suburb *

State *

Postcode *

Centrelink

Department of Veterans’ Affairs

You authorise Centrelink to confirm with Simply Energy the current status of your Commonwealth benefit and other details that relate to your concession entitlement. This involves electronically matching details you have provided to Simply Energy with Centrelink or Department of Veterans’ Affairs (DVA) records to confirm whether or not you are currently receiving a Centrelink or DVA benefit.
You understand that this consent, once submitted, is effective only for the period you are a customer of Simply Energy. You also understand that this consent, which is ongoing, can be revoked at any time by giving notice to Simply Energy.
You understand that if you withdraw your consent, you may not be eligible for the concession provided by Simply Energy.
A brochure is available from Centrelink that provides more details about the Centrelink Confirmation eServices or on Centrelink’s website at www.centrelink.gov.au

I have read and accept the terms and conditions for this concession consent