SECTION A - YOU, THE CUSTOMER. Please supply your contact details: red indicates a required field
Please complete your details in Section A if you have a problem with your energy or water company. If you are acting on behalf of someone else, then please complete their details in Section A, and enter your details in Section B
Title
First Name 
Surname 
Postal Address 
Suburb 
State 
Postcode 
Email address 
Please provide daytime and after hours contact numbers so we can talk to you about this complaint as soon as possible
Home Number
Work Number
Mobile Number
SECTION B - YOUR REPRESENTATIVE (OPTIONAL)
Please complete your details in Section A if you have a problem with your energy or water company. If you are acting on behalf of someone else, then please complete their details in Section A, and enter your details in Section B
Title
First Name 
Surname 
Postal Address 
Suburb 
State 
Postcode 
Email address 
Please provide daytime and after hours contact numbers so we can talk to you about this complaint as soon as possible
Home Number
Work Number
Mobile Number
If you are submitting this complaint on behalf of another person/supplier/organisation, please complete the Authority to Act form and attach to this complaint using the Attachment field below.
SECTION C - INCIDENT ADDRESS
Street Address
Suburb
State
Postcode
SECTION D - THE COMPLAINT
Has your electricity / gas supply been disconnected,
or has your water supply been restricted?
 
Name Of Supplier you wish to complain about: 
Account Number (If applicable)
What service is the complaint about? 
Have you contacted the supplier yourself to try and
resolve the complaint?
 
Please briefly describe the complaint including an outline of any responses the provider has given so far 
What are you or the customer seeking to resolve this complaint? 
What would be the best time
and day to contact you?
How did you hear about the Energy and Water
Ombudsman's Office?
Other? Please specify
Are you prepared to be contacted in future by EWOSA,
or contractors representing EWOSA, that can help us improve
our service?
If you have an attachment please browse to it
Attachment