DG1 Form

Application type
Application type*

New connection - In addition to this form you also need to complete the New Connections application formUpgrade to an Existing connection - If this application is for an existing connection please enter your unique ICP number below:
ICP Number
Site Details

This refers to the site where the distributed generation is to be installed
Site address*

Street Address

Street Address Line 2

CitySuburb

Postal / Zip Code
DPS*
Lot No.*
Other identifying remarks
Please state what this site will be used for*

DwellingCommercialIndustrialPumpOther
Distributed Generator Details

This is the party who owns and is responsible for the distributed generation installation
Full legal name*
Contact name*

First NameLast Name
Email*
example@example.com
Contact phone*

Area CodePhone Number
Physical address

Street Address

Street Address Line 2

CityRegion

Postal / Zip Code
Party

Individual / CoupleCompanyOther
Distributed Generation System Installer
Full legal name
Company
Contact name

First NameLast Name
Email
example@example.com
Physical address

Street Address

Street Address Line 2

CityRegion

Postal / Zip Code
Distributed Generation Type
Distributed generation type*

SolarGas turbineSteam turbineFuel cellWind turbineMicro hydroOther
Inverter Specification
Manufacturer / supplier*
Model number*
Rated capacity (kW) Note for micro-inverters this is total system capacity*
Export kW load value*
AS4777 compliant?*

YesNo
Is the inverter pre-approved? Counties Energy recognises all inverters approved by the Clean Energy Council. Visit www.solaraccreditation.com.au to search for approved inverters*

YesNo (If no documented evidence of inverters type test / approval to AS4777 and adherence to Counties Energy connection and operating standards including electrical protection* must be submitted with this application). *Includes protection to stop network reclosing causing equipment damage and the safeguarding of generation feeding back into the network on loss of supply.
Supporting information for inverter
Supporting documentation for inverter

Cancelof
Other details
Any other information or special terms that may be relevant to application
Supporting documentation

Cancelof
Distributed Generation Declaration

As the legal owner and distributed generator, we hereby request to connect a distributed generator device up to 10kW to Counties Energy Limited’s electricity network.

We confirm that the information submitted within this application is accurate and correct.

We hereby agree to comply with all requirements of a distributed generator as required under Part 6 of the Electricity Industry Participation Code 2010.

We confirm that we will inform Counties Energy of any future changes to the distributed generation installation.

We confirm that we will comply with all safety requirements as required by a distributed generator.

We confirm that we are aware of our responsibility to arrange for the installation to be tested and inspected, prior to connection.
We hereby accept all charges in relation to processing this distributed generation application form.

This document must be signed by the party that seeks to become the distributed generator. Third parties are not permitted to sign this document on behalf.
Distributed generator name*
Date

DayMonthYear
Date
Should be Empty:

Application type

Site Details

Distributed Generator Details

Distributed Generation System Installer

Distributed Generation Type

Inverter Specification

Other details

Distributed Generation Declaration