Claim form

ELECTRICITY EMERGENCY

13 10 93

GAS EMERGENCY

13 19 09

CONTACT US

Before you get started on this form, please note:

  • The issue and acceptance of this form does not constitute any admission of liability or fault by or on behalf of Evoenergy.
  • You will need to provide evidence of costs that you have incurred.

Depending on the nature of the claim, it may take up to 20 business days to receive an outcome. If you have any questions at any stage of the investigation, you can contact our claims team via email at claims@evoenergy.com.au.

Claim form

Important note

  1. The issue and acceptance of this form does not constitute any admission of liability or fault by or on behalf of Evoenergy.
  2. You will need to provide evidence of costs that you have incurred.
Security Policy

We take your privacy seriously – the information you give us will never be provided to third parties or used to send unsolicited emails.

Read Evoenergy's privacy and security statement.

*Denotes mandatory field

Your details

Postal address
Contact details

Incident details

Claim details

List the items you would like to seek compensation for in the table below, along with the amount you believe they are worth. The total cost of items will be automatically calculated. Under the ‘claim item’ column, include the make, model and age of all appliances.

Please note Evoenergy will review the below items and assess the replacement value of the claim taking into consideration the age and current resell value of the item being claimed.

Claim item Amount   should be a positive number, and can be decimal, e.g. 59.68
  $0.00

Please include additional information that you consider important to your claim, such as copies of receipts, quotes or reports.

Attachment can be an Office document or PDF.
Attachment can be an Office document or PDF.
Attachment can be an Office document or PDF.
Attachment can be an Office document or PDF.
Attachment can be an Office document or PDF.

Statement

I / We acknowledge that:

  1. All information provided, and statements made, are truthful and accurate and no information likely to affect the outcome of this claim has been withheld.
  2. I / We acknowledge that Evoenergy will rely upon information supplied by me when determining this claim.
  3. The property or goods, which are subject to this claim, are owned by me/ us.
  4. I have not made a claim for this damage to anyone else (including any insurers), nor will I make such a claim, if I accept any payment or other benefit from Evoenergy in the settlement of this claim.

Important note

  1. The issue and acceptance of this form does not constitute any admission of liability or fault by or on behalf of Evoenergy.
  2. You will need to provide evidence of costs that you have incurred.