I02 Disconnect Request: C

HomeI02 Disconnect Request: C

I02 Disconnect Request: C

Non-household customer 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 also the owner of the eligible premises for which the supply is to be disconnected?



If No, has the owner of the Non-Household Premises consented to the disconnection of the Service?



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



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



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

5. Non-Household Customer contact

The Wholesaler may wish to contact the Non-Household Customer to arrange a visit to the premises. Please indicate whether you give consent for the Wholesaler to contact the Non-Household Customer directly to arrange a visit to the premises?

YesPlease provide contact details below


Customer Contact Details

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



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 the authorised signatory

An authorised representative of the Non-Household Customer must sign this form.

8. *Retailer declaration

By submitting this form I accept the standard terms for disconnection activity in accordance with the Wholesaler?s 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.