Application for the NSW Government’s Family Energy Rebate Authorisation and Declaration

  • All particulars provided on this application form are, to the best of my knowledge, true and accurate.
  • I understand it is my responsibility to notify the NSW Department of Trade & Investment (the Department) of any changes to this information.
  • I authorise the Department to confirm with the Federal Department of Human Services (DHS), the status of my Commonwealth Benefit eligibility and/or receipt, and other details, as they pertain to the NSW Family Energy Rebate and the NSW Low Income Household Rebate, and where applicable, to notify my electricity retailer of my eligibility for, and receipt of, the NSW Family Energy Rebate.
  • I understand that the information in this form will only be used by the Department to determine eligibility for the Family Energy Rebate, which may include the above disclosures, and to audit the Family Energy Rebate program.
  • I understand that this authorisation, which is ongoing, can be revoked at any time by giving notice to the Department.
  • I understand that if I withdraw my authorisation, I may not be eligible for the NSW Family Energy Rebate.
  • I have read and understood the information contained within this application form.


To be eligible for the 2013-2014 NSW Family Energy Rebate, you must:

  1. 1. Be a NSW resident; AND
  2. 2. Have confirmation from the Federal Department of Human Services (DHS) that you are eligible for the Family Tax Benefit A or B during the 2012-2013 financial year, and received the relevant payment; AND
  3. 3. Be an account holder of an electricity retailer, or, a long-term resident of a caravan or mobile home park, whose name appears on the electricity account for supply to her/his principal place of residence.
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