energy concession form

Complete this form to update or add a concession to your energy account.

your details (as per your concession card)

* name

contact details

* address
* Is this your principal address?

concession card details

The Australian Government Department of Human Services, DHS, to provide the results of that enquiry to amaysim Energy.
DHS will use information I have provided to amaysim Energy to confirm my eligibility for the relevant concession or rebate and will disclose to amaysim Energy personal information including my name, address, payment and concession card type and status.
This consent, once signed, remains valid while I am a customer of amaysim Energy unless I withdraw it by contacting amaysim Energy in writing or the DHS.
I can obtain proof of my circumstances/details from the department and provide it to amaysim Energy so that my eligibility for the relevant concession or rebate can be determined.
If I refuse to give, or withdraw my consent or do not alternatively provide proof of my circumstances/details, I may not be eligible for the concession, rebate, or service.
I must advise amaysim Energy if my circumstances change and I am no longer eligible to receive a concession.