Multinet gas - PSP Application

Step 1: Applicant details

First Name*

Last Name*

Mobile Number

Either phone or mobile is required

Phone Number

Either phone or mobile is required

Email Address*

Meter Identification Reference Number (MIRN)*

You will find your MIRN on your gas retail bill (often on page 2). It should also be on your gas meter.

Residential Address House Number*

Street Address*

Suburb/Town*

Postcode*

State

Postal Address (if different to residential address)

Preferred Method of Communication (please select all that apply)

Telephone SMS Email Hardcopy / Letter (in the post) Other, please specify

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Preferred Language (please select)

Mandarin Italian Greek Vietnamese Other, please specify

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Step 2: Eligibility

The Priority Services Program has been designed to support customers who are experiencing vulnerability and need us the most. To assist us in determining if you, or someone in your household, is eligible to be included in the program we need to understand the nature of your current vulnerable circumstances.

Find out more about eligible circumstances here.

MGN will only use your personal information for the purposes for which it is collected. See our Privacy Policy for more information about the privacy protections that MGN gives your personal information.

Current Circumstances*s

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Step 3: Authorised Representative

As an MGN Priority Customer you can nominate an authorised representative to be added to your Priority Services account. This could be a family member, friend, or trusted neighbour, over 18 years of age.

A fully authorised representative has the authority to act on your behalf. An authorised representative is permitted to make changes to your account or request new services on your behalf.

Representative First Name

Representative Last Name

Email Address

Representative Phone Number

Representative Mobile Number

Representative Postal Address House Number

Suburb/Town

Street Address

Postcode

State

If you would like to discuss other authority options, please contact us via phone (1300 427 777) or email (customercare@agig.com.au).

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Step 4: Privacy Agreement

By completing and submitting this Priority Services Application form you are providing MGN with your consent to use your personal information to include you in the Priority Services Program and to process your personal information for the purposes of operating the program. By providing us with your personal information (which may include sensitive information), you consent to us collecting such information and to its disclosure within the Australian Gas Infrastructure Group* , but only for the purposes for which it was collected.

If you are accepted into the Priority Services Program, you agree that we may share your personal information (which may include sensitive information) with our contracted service providers or relevant third parties (e.g., gas fitters or plumbers) solely for the purpose of delivery services relating to the program.

The full details of MGN’s (part of the Australian Gas Infrastructure Group) Privacy Policy can be found here.

* The Australian Gas Infrastructure Group (AGIG) is comprised of Australian Gas Networks Limited ACN 078 551 685 (“AGN”), Multinet Gas Distribution Partnership ABN 53 634 214 009 acting on behalf of Multinet Gas (DB No 1) Pty Ltd ABN 66 086 026 986 and Multinet Gas (DB No 2) Pty Ltd ABN 57 086 230 122 (“Multinet”), DBNGP (WA) Nominees Pty Limited (ABN 78 081 609 289), as trustee of the DBNGP WA Pipeline Trust and AGI Development Group Pty Limited (DBP) and their related bodies corporate.

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Step 5: Confirmation

I wish to apply for the Priority Services Program.

I confirm that the person referred to in Step 1, as experiencing vulnerable circumstances, lives in my home.

I acknowledge that MGN has the right to reject my application if the eligibility criteria (outlined here) have not been met or my application is incomplete or inaccurate.

I confirm that all information provided in this application form is correct. I acknowledge that if MGN approves my application and it is subsequently discovered that I was not eligible for Priority Services, MGN reserves the right to charge me for any additional costs incurred as a result, such as providing me a gas appliance safety check, repair or appliance rebate.

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Priority Services Program Application Form

Step 1: Applicant details

Step 2: Eligibility

Step 3: Authorised Representative

Step 4: Privacy Agreement

Step 5: Confirmation