I01 Disconnect Request: R

HomeI01 Disconnect Request: R

I01 Disconnect Request: R

Retailer disconnection request



Items marked * must be filled in.

1. Retailer details


2. *Supply Point details

Premises address


Please indicate below the supplies which are to be disconnected


3. *Water supplies

Type of Disconnection

Permanent disconnection of the water supplies

Temporary disconnection / restriction of the water supplies

Unmetered water supply or supplies to be disconnected

Metered water supply or supplies

Meter details for each metered water supply to be disconnected - if there are more meters, please use additional sheets


Meter 1 Meter 2 Meter 3
Meter serial number
Meter manufacturer
Meter size1
Where the meter has an associated combination, please provide the serial number of the associated meter

3.1 Meter Information

Meter 1 Meter 2 Meter 3
Meter location (GIS X)
Meter location (GIS Y)
Meter 1 location
Meter 2 location
Meter 3 location

Out of hours disconnection

Tick if an out of hours disconnection is requested


4. *Information regarding the viability of the disconnection

Is the occupier of the premises liable under an agreement with the Retailer to pay the charges?

Yes

No

Has the Retailer served notice on the occupier requiring payment, which notice has not been disputed by counter notice

Yes

No

If the Retailerís notice has been disputed by counter notice, has the Retailer subsequently obtained either a court judgement against the occupier for the payment of the charges, or entered into an agreement with the occupier since service of the counter notice for the payment of the amount outstanding, and which the occupier is now breaching.

Yes

No

Have any applicable consumer protection measures been exhausted?

Yes

No

Is a copy of the validly served notice attached to this form?

Yes

No

Is the payment in the notice still outstanding?

Yes

No

As far as you are aware, do the water supply or supplies also supply any other premises (i.e. another Non-Household Customer or a Household Customer)?

Yes

No

In the case of a request for a disconnection / discontinuation of the water supply or supplies, is the occupier of the eligible premises a "Sensitive Customer"2?

Yes

No

As far as you are aware, will the disconnection affect the supply of water to premises that are listed in Schedule 4A of the Water Industry Act 1991 (see below)?

Yes

No

Is the occupier also the owner of the eligible premises of which the supply is to be disconnected / restricted / discontinued?

Yes

No

If No, has the owner of the eligible premises consented to the disconnection / restriction / discontinuation of the service?

Yes

No

If No, is a copy of the validly served notice of intention to disconnect attached to this form?

Yes

No

Has the period of notice expired?

Yes

No

Has any objection been raised to the notice of intention to disconnect?

Yes

No

Do you intend to use an Accredited Entity to perform the disconnection?

Yes

No

Has the Accredited Entity carried out an initial visit to confirm that the disconnection may proceed?

Yes

No

If the disconnection has taken place on the initial visit please indicate here


5. Non-Household Customer contact

Please indicate whether you give consent for the Wholesaler to visit the premises without involvement of the Retailer.

YesPlease provide contact details below

No

Customer Contact Details

Please indicate if you want to be notified of the date of the visit

Yes

No


6. Update following disconnection by an Accredited Entity .


Meter 1 Meter 2 Meter 3
Temporary disconnection Y/N?
Permanent disconnection Y/N?
Date of disconnection
Closing meter read

7. *Declaration

By submitting this form I accept the standard terms for disconnection activity in accordance with the Wholesalerís Wholesale Tariff Document.

For disconnection by the Wholesaler, if activity is for a standard disconnection in standard circumstances as priced in the Wholesale Tariff Document then it will take place without a quote being issued, and may take place on the first visit.

I hereby acknowledge and declare that the information provided in this form is correct and up to date at the date of submission, and that any applicable statutory or other regulatory requirement has been followed.

Summary of types of premises listed in Schedule 4A of the Water Industry Act 1991 which may not be disconnected for non payment

  • Any dwelling or any house in which any person has their only or principal home;
  • Accommodation for the elderly;
  • Any hospital or other premises used for the provision of medical or dental services;
  • A childrenís home;
  • A school or other educational institution;
  • A nursery or other premises which is used for registered childcare;
  • A prison or removal centre ; and/or
  • A premises occupied by the police, fire, rescue or ambulance services.

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