This form is used for: applying for Pensioner concession rebates on your electricity, water and/or sewerage.

To complete this form you will need:

  • Concession card number

Please note: if your water and sewerage account has two account holders and only one of you have an eligible card, your account is only entitled to a percentage of the rebate.

General enquiries form - for most enquiries.

We will endeavour to contact you within 5 working days. If you want to change your application or you have any questions about the form please contact us.

Contact us: 13 14 93

 

Application for energy concession (ACT & NSW) and / or water and sewerage pensioner/health care rebate (ACT only)

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What is this form? (PDF)

* Required fields

Account details

Please select the rebate type(s) you wish to apply for. Supply an account number if available.
If you do not know your account number or do not yet have one, please leave the account number fields empty.

*


(Please select one or both)
 
 
(If applying for energy concession)
 
(If applying for pension/health care rebate))

Applicant details

*
*
*   dd/mmm/yyyy
  (Example 25/Apr/1984)
Card details
*
*
*   dd/mmm/yyyy
  (Example 25/Feb/2014)

Contact details

*
 

Supply address

*
*
*
*

Authorisation

*
 

(Information provided by Centrelink and /or Veterans' Affairs is limited to a confirmation of you being a pensioner with fringe benefit eligibility and other details which need to be confirmed. The departments will under no circumstances release any other information to ActewAGL).

Office use only