This form is used for: Obtaining a certificate listing the current balance of the water and sewerage account.

To complete this form you will need:

  • a printer (connected to your computer - this form needs to be printed and returned to us)

Please note: This form requires a signature and a fee will be charged at the rate prescribed in the Water Schedule of Charges as specified in Miscellaneous fees and charges.

Please print the form, complete, sign and return with your payment to:

Customer Services ActewAGL

GPO Box 366

Canberra ACT 2601

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

 

Request for charges information

* Required fields

 
 
 

Name of applicant

 
 
 
 
 
 
 

I certify that

  1. I represent the lessee(s) of the land below and/or
  2. The information provided will be used for conveyancing purposes only.
 
 

Note: The details of individual accounts are confidential. Unsigned applications will not be processed.

 
SUBURB
SECTION
BLOCK
UNIT
VENDORS NAME
SOLICITOR REF
1
2
3
4
5
6

OFFICE USE ONLY

 
 
 
 

CHEQUES MUST BE PAYABLE TO ActewAGL

CHEQUES ACCEPTED SUBJECT TO CLEARANCE