DG1 Form

Application type

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

Other - Please specify

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

Is your postal address different from your physical address?

Postal Address

Street Address

Street Address Line 2

CityRegion

Postal / Zip Code

Party

Other

Distributed Generation System Installer

Full legal name

Company

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

Distributed Generation Type

Distributed generation type

Inverter Specification

Manufacturer / supplier

Model number

Number of phases exporting

Rated capacity (kW) Note for micro-inverters this is total system capacity

How are the micro-inverters balanced

Maximum Discharge Rate (kW)

Export kW load value

Expected export capacity (kW)

Is the inverter AS4777 compliant? This standard ensures the inverter meets safety and performance requirements

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

Proposed inverter installation date

Supporting information for inverter

Supporting documentation for inverter

Battery Specification

Manufacturer / Supplier

Model Number

Exact model number of the battery unit.

Nameplate Storage (kW)

The total energy storage capacity of the battery as listed on its nameplate.

Maximum Charge Rate (kW)

The maximum rate at which the battery can be charged.

Maximum Discharge Rate (kW)

The maximum rate at which the battery can release energy.

Other details

Any other information or special terms that may be relevant to application

Supporting documentation

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