Online concession Form

I confirm that the electronic signature in this consent represents my signature.

I consent to signing the form electronically and I confirm that my signature is legally binding.

I understand that:

To confirm I’m eligible to receive a concession, CovaU Energy need to collect and use my name, address and concession card information for the Services Australia or the Departments of Veterans Affairs. CovaU Energy will contact the Services Australia to do this.

My consent will be valid while I am a CovaU Energy customer or until I tell CovaU Energy to withdraw that consent, which I can do at any time.

I will notify CovaU Energy and the card issuer of any changes in my circumstances which may affect my eligibility for a concession.

If I do not provide this consent, CovaU Energy will be unable to provide me a concession unless I obtain proof of my eligibility from the Services Australia and provide it to CovaU Energy.

I agree to be contacted by phone by one of our energy experts to discuss your energy needs and eligible offers.

Privacy Note: We are collecting your information in order to verify your details so we can respond and deal with your request in accordance with privacy laws. For more information about how we collect, use, disclose and store your personal information and how you can access it, see our privacy page

I confirm that the electronic signature in this consent represents my signature.

I consent to signing the form electronically and I confirm that my signature is legally binding.

I confirm that I live alone or only with persons as described below:
• With my spouse/defacto and/or other persons who are wholly dependent on me
• With other people who hold a concession card or Queensland Seniors Card
• With other people who receive a Centrelink, Family Assistance or Dept of Veterans’ Affairs payment, and who DO NOT pay rent
• With other people who provide care and assistance, and who DO NOT pay rent AND
• I DO NOT share my residence with any other persons except casual visitors.


I advise that the supply above address is my principal place of residence and is the only residence within Queensland for which the rebate is claimed by me and the above energy account is solely or jointly in my name.
• I will notify CovaU immediately of any change in my circumstances which may affect my eligibility for the rebate.
• I authorise CovaU to disclose my personal information to Services Australia (Centrelink), Department of Veteran Affairs (DVA), Department of Immigration and Border Protection (DIBP) or Department of Communities, Disability Services and Seniors (DCDSS) and their service delivery agent (Card and Concession Services, Smart Service Queensland) in order to obtain confirmation of my eligibility for a concession.
• I authorise Centrelink, DVA, or DIBP to provide the results of that enquiry to CovaU and the Queensland Government.

I understand that:
• Centrelink, DVA, DIBP or DCDSS will use information I have provided to CovaU to confirm my eligibility for a concession and will disclose to CovaU personal information including my name, address, payment and concession card type and status.
• this consent, once submitted, remains valid while I am a customer of CovaU unless I withdraw it by contacting CovaU.
• I can obtain proof of my circumstances/details from Centrelink, DVA, DIBP, or DCDSS and provide it to CovaU so that my eligibility for the concession rebate can be determined. If I withdraw my consent or do not alternatively provide proof of my circumstances/details, I may not be eligible for the concession rebate provided by the Queensland Government. I declare that all the information that I have given is true and correct.

I agree to be contacted by phone by one of our energy experts to discuss your energy needs and eligible offers.

I confirm that the electronic signature in this consent represents my signature.

I consent to signing the form electronically and I confirm that my signature is legally binding.

I authorise

• My Electricity Retailer (as specified in the above section ‘Electricity retailer’s details’) and the Tasmanian Department of Treasury and Finance (State Revenue Office) to use Centrelink Confirmation eServices to perform a Centrelink/DVA enquiry of my Centrelink or Department of Veterans’ Affairs Customer details and concession card status in order to enable My Electricity Retailer and the Tasmanian Department of Treasury and Finance (State Revenue Office) to determine if I qualify, or continue to qualify for the Annual Electricity Concession.

• the Australian Government Agency of Services Australia (The Agency) to provide the results of that enquiry to My Electricity Retailer and the Tasmanian Department of Treasury and Finance (State Revenue Office).

• the Australian Department of Immigration and Border Security and the Tasmanian Department of Premier and Cabinet to provide My Electricity Retailer and the Tasmanian Department of Treasury and Finance (State Reve•nue Office) with any personal information relating to me that is relevant in determining if I qualify, or continue to qualify for the Annual Electricity Concession.


I also understand that:

• the Australian Government Agency of Services Australia, the Australian Department of Immigration and Border Security and the Tasmanian Department of Premier and Cabinet will use information I have provided to My Electricity Retailer and the Tasmanian Department of Treasury and Finance (State Revenue Office) to confirm my eligibility for Annual Electricity Concession and will disclose to My Electricity Retailer and the Tasmanian Department of Treasury and Finance (State Revenue Office) 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 My Electricity Retailer unless I withdraw it by contacting them or the applicable agency.

• I can obtain proof of my circumstances/details from the applicable agency and provide it to My Electricity Retailer and the Tasmanian Department of Treasury and Finance (State Revenue Office) so that my eligibility for the Annual Electricity Concession can be determined.

• if I withdraw my consent or do not alternatively provide proof of my circumstances/details, I may not be eligible for the Annual Electricity Concession provided by My Electricity Retailer and the Tasmanian Department of Treasury and Finance (State Revenue Office).

I agree to be contacted by phone by one of our energy experts to discuss your energy needs and eligible offers.