Queensland Government Solar Hot Water Rebate Guideline and Application

Similar documents
Renewable Energy Bonus Scheme - solar hot water rebate. Guidelines and application form

Applicant Information Booklet

Application form and lodgement guide

Carbon Neutral Adelaide

First Home Owner Grant

Carbon Neutral Adelaide

Bus Travel Assistance Safety-Net Application cont... 4 Names of students applying for bus travel assistance IMPORTANT: Student details must match reco

ILC DISABILITY EQUIPMENT GRANT. Application Form

Section 1 Eligibility criteria

DISABILITY EQUIPMENT GRANT INFORMATION & GUIDELINES

Promotion of Energy efficiency and renewable Sources of Energy In the domestic Sector Solar Water Heating Application Part 1 and Part II

I have attached one of the following forms of identification to confirm these details (please specify)

Enrolment Form - Domestic

CHC30113 Certificate III in Early Childhood Education and Care

Applicant Information Sheet for MASS 50 Continence Aids: Initial and Review Application

APPLICATION FORM AND LODGEMENT GUIDE

First Home Owner Grant application

Application for First Home Owner Grant

Solar Homes and Communities Plan Residential application for pre-approval

FOOD SAFETY SUPERVISORS COURSE

Application for a Gold Card for Veterans of Australia s Defence Force

Indigenous Commonwealth Scholarships Semester 1, 2016

Feed in Tariff Application Form

HOUSING AFFORDABILITY FUND REBATE APPLICATION FORM

APPLICATION FORM AND LODGEMENT GUIDE

Application for a licence to construct or alter a domestic and stock bore

CONSUMER GAME OF CHANCE COMPETITION SCHEDULE TO CONDITIONS OF ENTRY

NSW Life Support Rebate Application Form Retail Customers

NOTE: PARTICIPANTS IN THE NDIS ARE NOT ELIGIBLE FOR EQUIPMENT FOR LIVING GRANTS

10165NAT Certificate IV in Assistive Technology Mentoring

CB1. Please complete your name in the following boxes before completing the rest of this form.

2018 NEVILLE SAWYER SCHOLARSHIP APPLICATION FORM

THE BLUE SKY ALTERNTIVE INVESTMENTS BUSINESS SCHOLARSHIP FOR INDIGENOUS STUDENTS Application Form 2016

Home Energy Saving (HES) scheme - Homeowner Application Form Version 10.0

FEED-IN TARIFF LICENSEE TRANSFER

CHCPRT001 Identify and respond to children and young people at risk

Energ-E-News. July QCOSS Energy Project News

NSW QUAD BIKE SAFETY IMPROVEMENT PROGRAM REBATE APPLICATION FORM

TORRES STRAIT COMMUNITY SPORTS AND RECREATIONAL PROGRAM HEALTHY AND ACTIVE COMMUNITY GRANTS FUNDING GUIDELINES

Food Handlers Program

91397 Barrington Training Services Pty Ltd. Please complete all sections of this form and return to Barrington Training Services.

Study materials: Nominate your preferred format for Training and Assessment materials

RACQ Foundation. Guidelines and Application Form Natural Disasters. Funding Priorities Natural Disasters. Privacy. Eligibility Criteria

Home Energy Saving (HES) scheme - Homeowner Application Form Version 1.0

EDUCATION ENROLMENT FORM EXPRESSION OF INTEREST

Registering your business name

REIT Course Registration Form

Industrial Optimization Program: Feasibility Study

Heat Pump Rebate for ENERGY STAR Most Efficient Heat Pumps

2018 STUDY ASSISTANCE SCHOLARSHIP - SECTION 1 APPLICATION FORM

Indigenous Leadership Scholarship

YOUNG CARERS SCHOLARSHIP PROGRAM 2017 APPLICATION FORM

APPLICATION FORM LICENSED OCCUPATIONS

Request for Proposals and Specifications for a Community Solar Project

JIB UK-PHMES SMARTCARD CSCS Registration Application

Painters National Licensing Discussion Paper

2011 APPLICATION FORM

2018 VET CEO CONFERENCE HILTON BRISBANE 18 MAY 2018 SPONSORSHIP HANDBOOK

2012 TAFE eligibility exemption places information sheet

Application for Initial Assessment of Overseas Qualified Dental Prosthetist AS-3 V1

2018 NGĀPUHI EDUCATION SCHOLARSHIP POST-GRADUATE DIPLOMA BUSINESS MANAGEMENT (MAORI DEVELOPMENT) APPLICATION FORM

Australia s National Guidelines and Procedures for Approving Participation in Joint Implementation Projects

APPLICATION FOR ASSESSMENT AS A MEDICAL PHYSICIST FOR MIGRATION PURPOSES

RACQ Foundation. Natural Disasters. Guidelines and Application Form. Page 1

If this form is downloaded from the web please print all pages and complete by hand.

2016 National MAX Indigenous Art Competition

2011 TAFE eligibility exemption places information sheet

2018 SEMESTER ONE TE RŪNANGA O NGĀTI MUTUNGA EDUCATION GRANTS IMPORTANT PLEASE READ BEFORE COMPLETING YOUR APPLICATION

Enrolment Form. Other (please specify) Yes. Yes. Do you speak a language other than English at home? (If Yes, please specify)

Study materials: Nominate your preferred format for Training and Assessment materials

You MUST refer to the Explanatory Notes & Checklist to complete the application form.

Section 1 Eligibility Criteria Please answer the questions below by ticking ( ) the appropriate box.

Promotion of Renewable Energy Sources in the Domestic Sector PV Grant Scheme 2016/PV/ERDF - Application Part A

Application for admission into the Associate Degree of Applied Engineering (Renewable Energy Technologies)

ENGIE FEED IN TARIFF APPLICATION FORM. Version ENGIE FIT Application P a g e 0

Feed in Tariffs (FIT) Generator Application Form

Promotion of Renewable Energy Sources in the Domestic Sector PV Grant Scheme

SCHOOL OF HEALTH SCIENCES CRIMINAL HISTORY SCREENING & WORKING WITH CHILDREN CLEARANCES. South Australia. Northern Territory.

Home Energy Saving scheme. Application Guide Version 1.1

Utility Warehouse. Feed-In Tariff scheme. Application form

91397 Barrington Training Services Pty Ltd. Please complete all sections of this form and return to Barrington Training Services.

Application for an initial Medicare provider number for a medical practitioner

Aboriginal and Torres Strait Islander Health Practice Accreditation Committee - list of approved accreditation assessors

West Kimberley Community Grants Scheme

2016 Call. Operational Programme I European Structural and Investment Funds

Grant Application Package

Dodo Power & Gas. Customer Hardship Policy

2018 QUEENSLAND SCHOOLS VET CONFERENCE. sponsorship handbook. Educate Inspire Empower. Designed especially for VET in schools practitioners

Individual Application Form

Application form for Commissioning Generation Facility Registration by a Market Participant. including explanatory notes

Guidelines on a Grant on the Purchase of Roof Insulation and Double Glazing Products for Domestic Use that Reduce the Consumption of Energy.

Registration prescribed information handbook

ASPIRING EDUCATION FOUNDATION EQUITY SCHOLARSHIP

Application for Renewal of Manager s Certificate Section 224, Sale and Supply of Alcohol Act 2012

James Brown Memorial Trust

National VET Data Policy

Practice Incentives Program Indigenous Health Incentive and Pharmaceutical Benefits Scheme Co-Payment Measure Patient Registration and Consent

2018 NEWCASTLE LORD MAYOR S ARTS SCHOLARSHIP APPLICATION FORM

SPORTS EXCELLENCE SCHOLARSHIP FUND

2018 NZDE SCHOLARSHIP

Transcription:

Department of Employment, Economic Development and Innovation Queensland Government Solar Hot Water Rebate Guideline and Application Version: 2.0 Date: 23 July 2010 What is the Rebate? Right now, the Queensland Government is offering a Rebate to eligible Households that replace their electric storage hot water System with a solar hot water system or heat pump. You could be eligible for a: $1000 Rebate (for pensioners and low income earners) or $600 Rebate. The Rebate has strict Eligibility Criteria designed to ensure: that Queenslanders purchase quality Systems that are approved by the Australian Government s Office of the Renewable Energy Regulator (ORER) Systems are installed by suitably licensed Contractors, including plumbers, electricians and gas fitters. For the full Eligibility Criteria please refer to the terms and conditions at www.brightthing.energy.qld.gov.au or call 13 GET SOLAR (13 438 76527). Before You buy Get to know the market and find out about the range of solar water heaters, retailers, suppliers and installers. Determine the best System for Your needs. If You need help with this, download Helpful information about choosing a solar water heater from www.brightthing.energy.qld.gov.au or call 13 GET SOLAR (13 438 76527). Shop around for the best deal. Check Your preferred System and installation meet the Rebate Eligibility Criteria. Make sure the Contractors You employ have all the relevant licenses and qualifications. How do I apply? Step 1 Read the Eligibility Criteria and terms and conditions at www.brightthing.energy.qld.gov.au or by calling 13 GET SOLAR (13 438 76527). Terms defined in the terms and conditions have been capitalised throughout this booklet. If You agree with the terms and conditions proceed to step 2. Step 2 Complete the eligibility test on pages 4 5 to assess Your eligibility for the Rebate. Step 3 Replace Your existing electric storage hot water system with a compliant solar hot water system or heat pump. Tomorrow s Queensland: strong, green, smart, healthy and fair

V2 23.07.10 Step 4 Fully complete the rest of the Application Form. Please make sure You get: the seller of the System to complete the yellow Form (pages 8 9) the plumber/gas fitter to complete the blue Form (page 10) the electrical Contractor to complete the green Form (page 11). Some sections will be best filled out when You purchase the System and others on installation day. Make sure You have the most recent version of the Application Form check at www.brightthing.energy.qld.gov.au or call 13 GET SOLAR (13 438 76527). Step 5 Attach copies of the following documentation to Your completed Application: receipts that show proof of payment for the System and installation if on a payment plan a copy of the payment plan and proof of payments equalling the Rebate being applied for. Depending on the Rebate You have applied for, You may need to attach additional information (see checklist on page 3). For further details on what Your proof of payment needs to include, please see page 3. Step 6 Submit Your completed Application Form and supporting documentation to: Queensland Government Solar Hot Water Rebate Level 7, 61 Mary Street PO Box 15564 City East Qld 4002 What happens after I submit my Application? On receipt of Your fully completed Application, it will be assessed and if it is: accepted payment will be made to Your nominated bank account incomplete it will be returned to You for completion or declined You will be notified in writing that Your Application has been unsuccessful. Please allow six weeks processing time from the date Your Application is received. Want to save even more? You could save even more on the cost of Your System with the Australian Government s Renewable Energy Bonus Scheme. You could be eligible for a: $1000 Rebate for installing a solar hot water System or $600 Rebate for a heat pump. More information on the Australian Government s initiative can be found at www.environment.gov.au Got questions? Call 13 GET SOLAR (13 438 76527) or jump online www.brightthing.energy.qld.gov.au 2 23 July 2010 Queensland Government Solar Hot Water Rebate

Checklist Use this checklist once You and Your Contractor(s) have completed the Application Form. Make sure You use the most recent version of the Application Form check online at www.brightthing.energy.qld.gov.au or call 13 GET SOLAR (13 438 76527). V2 23.07.10 Have You: All applicants fully completed all sections of the Application Form including the eligibility test obtained all the information on the relevant forms, including license details and signatures, from all Contractor(s) engaged to supply and complete Your installation completed and signed the applicant declaration on page 7 Included copies of: OR proof of payment (System and installation) paid in full Your payment plan showing payments equalling at least the Rebate amount ($600 or $1000) For applicants with more than one System at the same Home Included copies of: electricity account for each System For $1000 applicants completed and signed the Pensioner/low incomer earner consent Form on page 12 For $1000 applicants not consenting to the Queensland Government confirming Your entitlement with Centrelink or DVA included a letter of proof of Your entitlement. What information needs to be on Your proof of payment? Your name, this must match the name on the Application The installation address The System cost (with supply and installation costs listed separately) The purchase date of the System Details of the System type, make, model and tank capacity Proof that the System and installation have been: paid for in full, or that You have a deferred payment plan. Supporting documentation Please only submit copies of Your documentation as these will not be returned to You. Queensland Government Solar Hot Water Rebate 23 July 2010 3

Application Form (Applicant to complete) Application Form Your eligibility for the Queensland Government Solar Hot Water Rebate will be determined on the information You provide. You must fully complete this Application Form. Some sections will be best filled out at the time of purchase and others on installation day. Incomplete Applications cannot be processed and will be returned to You without processing. This will delay Your Application. If You have further questions about the Rebate, please call the hotline on 13 GET SOLAR (13 438 76527) or visit the website at www.brightthing.energy.qld.gov.au 1. Complete the eligibility test (all applicants to complete) Please complete the following questions to determine Your eligibility for the Queensland Government Solar Hot Water Rebate. If You answer a question with the words, You are not eligible to apply next to Your response You do not meet the Eligibility Criteria for the Rebate and cannot submit an Application. Please tick the appropriate box for each question below Your System 1. Is the new System replacing an existing electric storage hot water System? 2. Did You pay, or enter into a payment plan, for a brand new System on or after 13 April 2010? (You are still eligible to apply if You paid a deposit prior to 13 April 2010) 3. Is the new System eligible for at least 20 Renewable Energy Certificates (RECs)? (The seller will be able to give You this information. For more information on RECs, visit the Office of the Renewable Energy Regulator at www.orer.gov.au) 4. Does Your System include minimum warranties of: five years tanks and solar collectors? two years circulating pumps (split solar systems) and refrigeration equipment (heat pump sealed systems)? Doesn t apply one year installation and workmanship? 5. Will the System be primarily used for heating a swimming pool or spa, or for business-related activities? You are not eligible to apply No 6. Is the new System replacing an existing gas, solar or heat pump hot water system? V2 23.07.10 You are not eligible to apply 7. Did You receive the System as a prize? You are not eligible to apply No No 4 23 July 2010 Queensland Government Solar Hot Water Rebate

Your Home 8. Is the System installed in a privately owned Home? (i.e. it is not housing owned by a federal, state, territory or local government) 9. Is the Home occupied by its owner or long term tenant for more than six months in any given year? 10. Is the Home a permanently fixed building? 11. Is the Home strata title (units, townhouses, etc)? You should not apply without approval from No the relevant authority (A relevant authority is the body corporate committee or other authorised entity under the strata title arrangements that apply to the property.) You 12. Are You an Australian citizen or permanent resident aged 18 years or over? 13. Are You the owner or tenant of the Home where the System is to be installed? Owner Other You are not eligible to apply Tenant You should not install a System without approval from the owner of the Home 14. Have You previously received a Rebate under the Queensland Government Solar Hot Water Rebate at the nominated installation address provided? You can only apply for more than one Rebate No if You hold separate electricity accounts at the one address 15. Have You previously received a system under the Queensland Government Solar Hot Water Program at the nominated installation address provided? You can only apply for a Rebate if You hold No separate electricity accounts at the one address 16. Are You submitting this Application within six months of the Installation Date? 17. Are You the holder of one of the following concession cards? Centrelink Pension Concession Card Centrelink Low Income Health Care Card DVA pensioner concession card* Commonwealth Seniors Health Card. *Blue only. Orange, white and gold cardholders are not eligible. You may be eligible for the $1000 Rebate, complete and sign the Pensioner/low incomer earner consent Form on page 12 If You are eligible to apply for a Rebate please make sure You complete the rest of the Application Form and submit it within six months of the Installation Date. No Application Form (Applicant to complete) V2 23.07.10 Queensland Government Solar Hot Water Rebate 23 July 2010 5

Application Form (Applicant to complete) 2. Applicant information (to be completed by applicant) Application no. (Office use only) ALL sections of this Form must be completed Applicant details Title First name Surname Installation address Unit no. Street no. Street name Suburb Town QLD Postcode 4 Postal address (if different from installation address) Unit no. Street name or P.O. Box no. Suburb Town Street no. State Postcode Contact details (please provide at least one contact phone number) Daytime contact no. OR Mobile Email Electronic funds transfer (EFT) details BSB no. Financial institution (if provided, this will be the primary method of contact) Account no. (If You are unsure of the BSB number, please contact the financial institution where the account is held.) Account name The Rebate payment for successful applicants will be made by direct deposit, via electronic funds transfer ( EFT ) only. The direct deposit will only be made to a bank account with a financial institution that is an authorised deposit-taking institution under the Banking Act 1959 (Cth), e.g. a bank, building society, credit union that is authorised to carry on a banking business in Australia. No direct deposit will be made to an account with a financial institution that is not an authorised deposit-taking institution. The Rebate is not available as a point of sale discount, nor can the retailer, installer or any commercial business apply for the Rebate on behalf of their customers. V2 23.07.10 6 23 July 2010 Queensland Government Solar Hot Water Rebate

Applicant declaration I, certify that (tick to confirm): (print name in block letters), I have read and agree to the all of the Queensland Government Solar Hot Water Rebate terms and conditions. The information which I have provided in my Application (including information which I have attached) is complete, true and correct. By signing this Applicant Declaration, I: agree to the use and disclosure of my personal information on the terms set out in clauses 5 and 6 of the terms and conditions on and from the date I sign this applicant declaration; acknowledge that under clause 5 and 6 of the terms and conditions, I agree to the disclosure of information about my Application to entities with responsibility for ensuring that the System and its installation comply with applicable standards and/or Laws, even if my Application is incomplete or I am not eligible for the Rebate; and agree that my Application (including the Guideline and its terms and conditions), upon notification of its acceptance by the Queensland Government, creates a binding legal agreement between myself and the Queensland Government, in consideration of the Queensland Government agreeing to pay the Rebate to me. DO NOT sign the applicant declaration until all Contractor(s) have completed and signed their Forms (pages 8 11). If You are applying for the $1000 Rebate You will also need to complete and sign the Pensioner/low incomer earner consent Form on page 12. Signature (signature must be an original, photocopies will not be accepted) Date d d / m m / 2 0 y y Would You like to receive information on energy efficiency and how You can help combat climate change?, via Email OR Post (please select and check You have provided the appropriate e-mail or postal address) No Submit Your completed Application and supporting documentation to: Queensland Government Solar Hot Water Rebate Level 7, 61 Mary Street PO Box 15564 City East Qld 4002 Got questions? Call 13 GET SOLAR (13 438 76527) or jump online www.brightthing.energy.qld.gov.au Application Form (Applicant to complete) V2 23.07.10 Queensland Government Solar Hot Water Rebate 23 July 2010 7

Application Form (Seller to complete) V2 23.07.10 2. System details (to be completed by seller on day of purchase) ALL sections must be completed incomplete Applications will be returned to You for completion Seller details Business name Phone 07 4084 0694 OR Mobile Email (if provided, this will be the primary method of contact) Did you (the seller) arrange any part of the installation? x please provide Your BSA licence details (below) System details BSA licence no. Name on licence Manufacturer Model no. Tank storage capacity Warranty details (BSA details required as per the Queensland Building Services Authority Act 1991 if the seller has arranged any part of the installation) litres No (as listed with ORER) (as listed with ORER) Tank 7 yrs Collector 7 yrs (min. 5 years) (min. 5 years) Refrigeration equipment yrs Circulating pump 2 yrs (Heat pump sealed system) (min. 2 years) (Split solar system) (min. 2 years) Type of System OR Solarcore admin@solarcore.com.au 1096105 John Russell Chromagen 8302VOBP10 8301VOBC12 8302TOBP10 8301TOBC12 300 Installation and workmanship (required if installation arranged by seller) Heat pump (Please tick one of the following options) Split (Compressor sits separate to tank) yrs (min. 1 year) Close coupled (Compressor sits on top/side of tank) Solar hot water System (Please tick one of the following options) Split Close coupled Please tick one of the following options: 1 Booster: x Electric OR Gas 8 23 July 2010 Queensland Government Solar Hot Water Rebate

Cost details System Price* $ Installation cost # $ Total cost $ REC Price (per REC) $ OR Customer arranging sale of RECs (REC Renewable Energy Certificate) * This is the cost of the System only, after any supplier discount is applied but before any RECs discount is applied, and does not include installation costs or regulatory (council etc.) fees. # This includes regulatory (council etc.) fees. I certify that I hold all the necessary licenses to supply, and where appropriate, arrange installation of the System described in this Form. I certify that the supplied System described in this Form is a new, working and complete System eligible for 20 RECs or more. I certify that the information provided by me in this Form is truthful and correct. I acknowledge the Information Privacy Act 2009 (Queensland) applies and consent to the Queensland Government using and disclosing the information which I provide in this Form to any regulatory body or council for the purposes of ensuring that I hold those licenses and approvals which I am required to hold by Law in order to quote on and install the System described in this Form and to verify the information and certifications I provide in this Form. Seller s signature (signature must be an original, photocopies will not be accepted) Print name Date d d / m m / 2 0 y y Application Form (Seller to complete) V2 23.07.10 Queensland Government Solar Hot Water Rebate 23 July 2010 9

Application Form (Licensed plumber and/or gas fitter to complete) V2 23.07.10 3. Licensed plumber s and/or gas fitter s details (to be completed by plumber and/or gas fitter on or after day of installation) ALL sections must be completed incomplete Applications will be returned to You for completion Are you: x the plumber the gas fitter both (If the plumber and gas Date installed d d / m m / y y Tank serial no. Business name ABN Title Surname are not the same person, each must print and complete a copy of this Form.) First name BSA licence no. 109615 Name on licence John Russell (Required as per the Queensland Building Services Authority Act 1991 if the applicant has arranged the plumber or if the supplier does not hold a current Plumbing and Drainage BSA licence) Email Phone 07 4084 0694 OR Mobile Occupational licence no. Is your licence endorsed for installing solar hot water systems and heat pumps? Warranty on installation and workmanship Name on licence No (min. 1 year) Please complete the following if you are also the licensed gas fitter that connected the booster of the new solar hot water system: Occupational licence no. Solarcore 58 143 299 183 Mr L Russell 21779 Warranty on installation and workmanship Name on licence I certify that the System described in this Form has replaced an electric storage water heater. (min. 1 year) I certify the System to be fully functional and installation is fully compliant with all relevant Laws, government codes, policies, guidelines and industry standards including the current Australian/New Zealand Standards and where an Australian/New Zealand Standard does not exist, any relevant current International Standard (ISO) for which I am responsible, and including building codes and requirements of the of the Renewable Energy Regulator. I certify that I have lodged all required documents and paid all required lodgement fees associated with the installation of the System. I certify that the System is for domestic purposes only (not for non-domestic use or for the heating of a pool, spa or similar purposes). I certify that the information provided by me in this Form is truthful and correct. I acknowledge the Information Privacy Act 2009 (Queensland) applies and consent to the Queensland Government using and disclosing the information which I provide in this Form to any regulatory body or council for the purposes of ensuring that I hold those licenses and approvals which I am required to hold by Law in order to quote on and install the System described in this Form and to verify the information and I provide in this Form. I certify that I have issued a Gas System Compliance for the gas installation to the owner and the gas supplier as required under relevant Law (applies to licensed gas only). Plumber/gas fitter s signature x 1 John (signature must be an original, photocopies will not be accepted) Date d d / m m / y y 10 23 July 2010 Queensland Government Solar Hot Water Rebate

4. Electrical Contractor s details (to be completed by the installing electrical Contractor on or after the day of installation) ALL sections must be completed incomplete Applications will be returned to You for completion Business name ABN Title Surname Date your works completed d d / m m / y y Electrical Contractor s licence no. (gold card) Email Solarcore 58 143 299 183 Mr First name Van Hout Name on licence Darryn 73289 Solarcore Pty Ltd Phone 07 4084 0694 OR Mobile Application Form (Electrical Contractor to complete) V2 23.07.10 Electrical worker s licence no. State q l d Name on licence What was the old water heater connected to? T11 T33 T31 What tari is the new solar water heater electric booster connected to? T11 T33 T31 (You are not required to answer this question if the booster is gas) Power rating of the new solar water heater s electric booster watts Warranty on installation and workmanship 1 (min. 1 year) I certify the installation of the System described in this Form is fully compliant with all relevant Laws, government codes, policies, guidelines and industry standards including the current Australian/New Zealand Standards and where an Australian/New Zealand Standard does not exist, any relevant current International Standard (ISO) for which I am responsible. I certify that a of Testing and Compliance/Safety has been issued to the applicant for all electrical works associated with the installation of the water heater that is the subject of this Application. I certify that I have lodged all required documents and paid all required fees associated with the installation of the new System. I certify that the information provided by me in this Form is truthful and correct. I acknowledge the Information Privacy Act 2009 (Queensland) applies and consent to the Queensland Government using and disclosing the information which I provide in this Form to any regulatory body or council for the purposes of ensuring that I hold those licenses and approvals which I am required to hold by Law in order to quote on and install the System described in this Form and to verify the information and I provide in this Form. Electrical Contractor s signature (signature must be an original, photocopies will not be accepted) Date d d / m m / y y V2 23.07.10 Queensland Government Solar Hot Water Rebate 23 July 2010 11

Application Form ($1000 applicants to complete) V2 23.07.10 5. Pensioner/low income earner consent (to be completed by $1000 applicant) This section must be completed if You are applying for a $1000 Rebate. The applicant and the cardholder must be the same person. You must be the applicant and the card holder, and must occupy and own or tenant the property this Application is for. It is important to note that only one Rebate can be claimed per system, and only one Concessional Rebate will be granted per Applicant. The relevant card must be current as at the date shown on the proof of purchase and installation. This consent will be used for the sole purpose of authorising Centrelink to provide information to the Queensland Government to assess Your eligibility for the Concessional Rebate. The Queensland Government will be required to perform numerous checks to ensure the currency of Your pension or concession card to determine Your eligibility for the Concessional Rebate. Entitlement details Please provide Your Centrelink or DVA customer reference number (CRN). This number can be found on Your Pension Concession Card, Low Income Health Care Card or Commonwealth Seniors Health Card in the form of nine digits followed by a letter (e.g. 123 456 789A) or a Q followed by up to nine digits and/or letters (e.g. Q 123 456 789 or QSS 12345). Your Centrelink CRN number Your DVA number is Please tick one of the following options: I give consent for the status of my Commonwealth benefit to be confirmed No I do not give consent for the status of my Commonwealth benefit to be confirmed If You ticked No, You must provide proof* from Centrelink or the DVA with this Application confirming that You hold either a: Centrelink Pension Concession Card DVA pensioner concession card # Centrelink Low Income Health Care Card Commonwealth Seniors Health Card. *A letter from Centrelink or DVA confirming the benefit You are currently receiving is an acceptable form of proof. A photocopy of Your Concession or Health Card will not be accepted as proof confirming Your Centrelink entitlement. # Blue only. Orange, white and gold cardholders are not eligible. Make sure You complete and sign the customer confirmation on the following page. Q 12 23 July 2010 Queensland Government Solar Hot Water Rebate

Customer confirmation ($1000 applicants only) I, (print name in block letters as shown on Your relevant card) authorise Centrelink to confirm with the Queensland Government the current status of my Commonwealth benefit and other details as they pertain to my concessional entitlement. This involves electronically matching details I have provided to the Queensland Government in this Application with Centrelink or Department of Veterans Affairs (DVA) records to confirm whether or not I am currently receiving a relevant Centrelink or DVA benefit, and: I understand that this consent, once signed, is effective only for the period on and from the date of signature of this Form until notified of whether my Application is accepted or not. I also understand that this consent can be revoked any time by giving notice to the Queensland Government. I understand that if I withdraw my consent, I may not be eligible for the $1000 Rebate provided by the Queensland Government. Your date of birth d d / m m / y y y y Signature (signature must be an original, photocopies will not be accepted) If You would like more information about the Centrelink Confirmation eservices, a brochure is available from Centrelink or at www.centrelink.gov.au Application Form ($1000 applicants to complete) V2 23.07.10 V2 23.07.10 Queensland Government Solar Hot Water Rebate 23 July 2010 13