Claims

Please be advised that:

• The provision of this form by Multinet Gas does not constitute and should not be relied upon as constituting any admission of liability by Multinet Gas to any of the matters alleged by you.
• To expedite Multinet Gas’s review of your claim, please ensure you provide sufficient evidence to support your claim. Multinet Gas’s investigations will not commence until all such information has been received.

Your Details

Title: ---MsMrsMissMr

First Name:

Last Name:

You are claiming as: ---TenantLandlordOther

Supply Address (where incident occured):

MIRN (Meter Installation Registration Number) or Meter Number if known:
(MIRN is located on your Gas Bill. 11 digit number starting with 5310)

Postal Address (if different to address above):

Phone number:

Email address:

Incident Details

Date of incident:

Tell us what happened:

Particulars of Claim

Having regard to the matters set out above, including the evidentiary requirements, please provide details (including documentation) in support of your claim.

Important Information

When required, Multinet Gas will assess claims relating to a network fault in accordance with the Gas Distribution System Code v11 issued by the Essential Services Commission of Victoria (ESC).

A copy of the code is available on request; or can be viewed on the Essential Services Commission’s website: www.esc.vic.gov.au.

It is your responsibility to arrange repairs or obtain repair quotes. Any costs incurred will be your responsibility until a full assessment of your claim has occurred.
Multinet Gas may be unable to accept responsibility for claims that are a result of causes outside of its control.

Evidence of Claim

Sufficient evidence must be submitted when requesting compensation believed to be due to a Multinet Gas network supply fault. Your claim will not be processed until sufficient evidence has been provided.

If you are claiming plumber’s call-out fees
Multinet Gas requires an invoice or report from a Registered Plumber stating the incident date and the work completed during the call-out.

If you are claiming appliance damage
Multinet Gas requires a repair assessment from a Registered Repairer or manufacturer stating the cause of damage to your appliance.

Note: Evidence must be submitted to progress your claim. Evidence is to be submitted on plumber’s or repairer’s company letterhead.

Attach File (jpg, png or gif):

Declaration

(Please read carefully)

By signing this form, you acknowledge that:

• The information you have provided is true and accurate. Your claim may be refused if information is deemed untrue or incorrect
• Delays may occur in processing your claim if insufficient evidence has been submitted
• You are the owner of the damaged appliance(s) identified in this form and no other person(s) will make a claim against Multinet Gas for the same incident
• In submitting this form, you will co-operate with Multinet Gas and its authorised independent assessors, or any other third party who Multinet Gas may engage in relation to your claim
• Personal information collected on this form will be used to process and administer your claim
• Your personal information may be shared with our contracted service providers or third parties (eg repairer/assessor) for the purpose of claim assessment, and you consent to this disclosure
• The claim process may also involve the collection of additional personal information regarding the claim from a third party (ie repairer/assessor) and you consent to this collection and disclosure
• Your personal information may be contained in reports commissioned by Multinet Gas to process your claim. These reports are the sole property of Multinet Gas

  Note: Full details on how your personal information (including sensitive) may be used, handled or disclosed by us and how you may request access to your personal information is contained in our Privacy Policy at http://www.uemg.com.au

• You have read and submitted all pages in this Multinet Gas Claim Form
• Multinet Gas reserves its right at law.

I acknowledge the declaration above

I am aware that I must attach at least one piece of evidence of my claim