Account closure & transfer request
T0: Origin Fax: 1800 814 309
Email:
1 PROPERTY DETAILS (PLEASE COMPLETE ALL SECTIONS)
Lot no. Unit/Flat no. Street no.
Street Suburb
State Postcode
Date of account closure // Type Electricity Natural Gas
2 BUILDER DETAILS (PLEASE PRINT IN BLOCK LETTERS)
Builder name ABN
Registered address Suburb
State Postcode
Phone
Builder’s signature Date //
Note: By signing this document you warrant that you are authorised to sign on behalf of the builder whose details you set out above.
3 NEW HOME OWNER DETAILS (CURRENT PHONE NUMBER MANDATORY)
First name Surname
Current address Date of birth //
Suburb State Postcode
Existing home phone Work phone Mobile
I would like to take up Origin electricity and/or natural gas at the property listed in section 1. I understand and agree that Origin will try to contact
me by telephone in order to set up an Origin account. I also understand that a standard, deemed or default contract (as applicable under the relevant regulatory requirements) for electricity and/or natural gas (as applicable given my selection in section 1 above) will be deemed to exist if:
· Origin cannot contact me and I do not return Origin’s call or otherwise set up an account with Origin within five business days of the date of
account closure above; and
· we were supplying the builder listed above with electricity and/or natural gas, the electricity and/or natural gas services remain connected and
I take supply of electricity and/or natural gas.
I agree to Origin collecting, using, holding and disclosing my personal and credit related information in accordance with its privacy and credit reporting statements, available at originenergy.com.au/privacy. Origin’s credit reporting statement explains who Origin discloses credit information to (including service providers overseas) and how this could affect an individual’s creditworthiness, as well as how an individual can access, correct or complain
about it. Please contact Origin to request a paper copy.
Home owner’s signature Date //
The standard, deemed or default contract referred to above will only apply for a fuel if Origin was supplying that fuel to the builder. If we weren’t supplying
the builder with a fuel and we can’t contact you to set up an account, please contact us on 13 24 63 organise the supply of that fuel to your property.
IMPORTANT INFORMATION
Please fax or email this form to the number or address above at least 5 working days prior to your requested date of closure to ensure closure of
your electricity and/or natural gas account on the day you have specified. Clear and safe access to your electricity meter and/or natural gas meter
is required to complete this request.