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INTERNAL REFERENCE NUMBER
VEEC ASSIGNMENT FORM
Gas space heating and cooling - Residential
Important information
Consumers that undertake a prescribed activity such as installing a Solar/Gas hot water system, space heater and/
or gas dryer, can create Victorian Energy Efficiency Certificates (VEECs) under the Victorian Efficiency Target Act
2007. One VEEC represents one tonne of carbon dioxide equivalent (CO2-e) to be reduced by the activity.
Consumers are able to assign their right to create VEECs to an accredited entity. In assigning your rights to
Ecovantage, Ecovantage will be entitled to create and own the certificates that were produced as a result of your
decision to install a Solar/Gas hot water system, space heaters or gas dryer. In return, you will be provided with an
identifiable benefit from the installing company, such as a price reduction on the unit or a cash-back arrangement.
Consumers should be aware that it is their responsibility to negotiate satisfactory terms with the installing entity for
their assignment.
Declaration by installer
I hereby declare that:
> I am licensed to undertake the installation of the above system
> The system has been installed on residential premises
> The replaced system has been removed from the residential premises and has been decommissioned (where installation does not
involve a pre-heater or retrofit)
> The installation meets all relevant laws, standards, building codes and local council requirements including (AS4553)
> The information provided is complete and accurate and that I am aware that penalties can be applied for providing misleading
information in this form under the Victorian Energy Efficiency Target Act 2007
Installer Signature:
PART A: Installation details (INSTALLER TO COMPLETE)
Installer Name:
PART B: Resident details (RESIDENT TO COMPLETE)
Title:
Town/Suburb:
PostCode:
Electrician Name:
Mobile Number:
Town/Suburb:
Mobile Number:
Gasfitter Name:
Company Name:
Gasfitter license number:
5 Decommissioning ducted gas and installing high efficiency ducted gas
6 Decommissioning central electric resistance and installing high efficiency ducted gas
7 Decommissioning ducted air to air heat pump and installing high efficiency ducted air to air heat pump (non gas-reticulated areas)
8 Decommissioning central electric resistance and installing high efficiency ducted air to air heat pump (non gas-reticulated areas)
9 Installing a flued gas/LPG space heater
10 Installing a space air to air heat pump (non gas-reticulated areas)
20 Installing a high efficiency ducted gas heater where no other central heating or cooling product is installed
23 Decommissioning refrigerative air conditioner and installing evaporative cooler
FORM OF BENEFIT PROVIDED:
Delayed cash
Free installation
Other
Postcode:
Telephone Number:
Installation Date:
Has this residence claimed VEECS from another supplier for this activity?
WHAT TYPE OF SYSTEM IS BEING INSTALLED?
System model:
Surname:
Email Address:
Yes
No
If yes, give reason:
Mobile Number:
Brand/manufacturer:
First Name:
Installation Address:
Company Name:
Electrician license number:
Price reduction
Date:
Company Name:
Company Address:
1300 740 855
[email protected]
161 Victoria Pde,
Collingwood Victoria
Australia 3066
Was wiring work required for work undertaken in respect of the above installation?
Yes
Have you received a certificate of Electrical Safety for the work?
Not required
Yes
No
Declaration by Authorised Signatory
I hereby declare that:
> I am the
tenant
landlord
owner (please mark as appropriate) of the residence at the above installation address
> Where a replacement has occurred, the replaced heating system has been removed from the premises
> The information provided by the installer in Part A is correct and complete
> I understand that by signing this form I am assigning the right to create VEECs for the system to Ecovantage
> I have received an identifiable benefit from
in exchange for assigning my rights to create certificates for the
above system/installation
> The Essential Services Commission has the right to inspect the system/installation with reasonable notice provided
> I understand that information on this form will be disclosed to the Essential Services Commission for the purpose of creating
certificates under the Victorian Energy Efficiency Target Act 2007 and for related verification, audit and scheme monitoring purposes
> I am aware that penalties can be applied for providing misleading information in this form under the Victorian Energy Efficiency
Target Act 2007
> I understand that Ecovantage Pty Ltd will collect information on this form for the purpose of complying with the Victorian Energy Efficiency Target Act 2007 and I authorise it to use and disclose information about me to its related companies and other
organisations that assist it for this and related purposes, including to provide me with marketing information about Ecovantage
products and services
Amount of benefit provided for assignment of certificates: $
Anticipated number of VEECs created from this activity:
Resident Signature:
Date:
INSTALLATION CERTIFICATE DETAILS
Compliance certificate/gas fitting notice number (must attach copy):
Certificate of electrical safety number (must attach copy):
No
REBATE DOCUMENT CHECKLIST (Documents to accompany this signed, original, VEEC assignment form)
Decommission Form
Purchase Receipt (must attach copy)
Plumbing Compliance Copy
Electrical Safety Copy (Heating, Electric to Gas)
For more information: Phone us on 1300 740 855 Email us at [email protected] Visit at 161 Victoria Pde, Collingwood VIC 3066 Post to PO Box 390 Abbotsford VIC 3067
INTERNAL REFERENCE NUMBER
Declaration of decommissioning form
(heating, hot water unit, refrigerated airconditioning)
For more information contact us on
or email us at
1300 740 855
[email protected]
161 Victoria Pde,
Collingwood Victoria
Australia 3066
CONSUMER DETAILS
Title:
First Name:
Surname:
Decommission Address:
Town/Suburb:
Postcode:
Telephone Number:
Mobile Number:
Job number:
Decommissioned Hot Water / Heating / Refrigerated Airconditioning Unit Details
Brand / Manufacturer:
System Model:
Hot Water Type
Electric
Heating Type
Gas ducted
Gas
Approximate Age (years)
Electric slab floor heating
Electric space bank
Ducted air to air heat pump
Approximate age (years)
Area of house currently being heated by electric floor heating (minimum 100m )
2
Airconditioning Type
Ducted
Other (describe)
How has the unit been decommissioned?
HOT WATER ONLY
Holes in tank
Removed element
HEATING ONLY
Removed motor
Disconnected from mains power
Cut wires
Other (describe)
Date of decommission:
How has the unit disposed?
Sent to recyclers
Picked up by recyclers
Name of recyclers
Other (describe)
If the unit could not be removed from site, please provide reason:
Too big to remove from ceiling
In slab
Under floor
Other (describe)
Installer Name:
Company Name:
Installer Signature:
Installer Telephone Number:
Date:
For more information: Phone us on 1300 740 855 Email us at [email protected] Visit at 161 Victoria Pde, Collingwood VIC 3066 Post to PO Box 390 Abbotsford VIC 3067