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Extended outage payment scheme form

Incident details

Is this a meter or a submeter?
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Please enter your meter number below and click Validate meter to confirm the property address. 

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Please enter your meter number below and click Validate meter to confirm the property address. 

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Contact details

Payment details

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Please review your bank account details. Providing incorrect details will delay your payment. 

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Please review your bank account details. Providing incorrect details will delay your payment. 

Remittance
You will be notified of remittance via the email you have provided

Conditions of agreement
  • Western Power is under no obligation to verify the correctness of the bank account details. Should any of the above particulars alter, the claimant must complete and send a new application form to Western Power.
  • Western Power does not verify the authority of the claimant on the bank account details and accepts the authority of the claimant as conclusive evidence of authority to execute this agreement on behalf of the Synergy account holder.
  • Western Power will not be responsible for any delays in payment or error due to factors outside the reasonable control of Western Power including delays in the banking system.
  • Western Power reserves the right at any time to terminate or suspend this direct credit payment method and to pay by cheque or any other manner which Western Power may determine.
  • This authority supersedes all previous authorities.
     
Claim declaration
This Claim is made because the property in this application was affected by a power interruption of 12 hours or more in the last 60 days.
 
By submitting this form, I agreed that:
  1. I have read and agree to the extended outage payment scheme eligibility criteria and terms & conditions.
  2. I have not previously applied for payment for same outage at the same address.
  3. All the information provided is true and correct.
Remittance
You will be notified of remittance via the email you have provided

Conditions of agreement
  • Western Power is under no obligation to verify the correctness of the bank account details. Should any of the above particulars alter, the claimant must complete and send a new application form to Western Power.
  • Western Power does not verify the authority of the claimant on the bank account details and accepts the authority of the claimant as conclusive evidence of authority to execute this agreement on behalf of the Synergy account holder.
  • Western Power will not be responsible for any delays in payment or error due to factors outside the reasonable control of Western Power including delays in the banking system.
  • Western Power reserves the right at any time to terminate or suspend this direct credit payment method and to pay by cheque or any other manner which Western Power may determine.
  • This authority supersedes all previous authorities.
     
Claim declaration
This Claim is made because the property in this application was affected by a power interruption of 12 hours or more in the last 60 days.
 
By submitting this form, I agreed that:
  1. I have read and agree to the extended outage payment scheme eligibility criteria and terms & conditions.
  2. I have not previously applied for payment for same outage at the same address.
  3. All the information provided is true and correct.