Consent Form

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This field is for validation purposes and should be left unchanged.
Customer Name:*
Date:*
DD slash MM slash YYYY
Consent for Solahart Albany to apply on the customers behalf to
Synergy for the Distributed Energy Buyback Scheme (DEBS)
And
Western Power for the Approval of Connection and Installation of an Inverter System PV
I [name from above] give Solahart Albany consent to complete and submit an application on my behalf to Synergy for the purposes of registering a distributed energy system and enter into a contract with synergy for the Distributed Energy Buyback Scheme (DEBS) and Western Power for the Approval of Connection and Installation of an Inverter System PV.*
- I have been informed, if I have an existing system, that modification to the system may affect my
  a) Feed-in tariff eligibility; or
  b) Renewable Energy Buyback Scheme eligibility; or
  c) Distributed Energy Buyback Scheme eligibility; and/or
  d) connection requirements in respect of emergency solar management, and the customer has consented for us to submit this application.
Checkbox 2*
- I will comply with Western Power’s technical connection requirements and ensure a Western Power bi-directional meter has been installed prior to the transfer of electricity from the distributed energy system into Western Power’s electricity network.
Checkbox 3*
- I authorise Synergy to verify the system installation with State and/or Federal Government agencies and entities as required.
Checkbox 4*
- I have read and understood the Distributed Energy Buyback Scheme application https://www.synergy.net.au/Your-home/Manage-account/Solar-connections-and-upgrades/Distributed-Energy-Buyback-Scheme,
  and the emergency solar management requirements applying from 14 Feburary 2022 https://www.synergy.net.au/Your-home/Manage-account/Solar-connections-and-upgrades/Distributed-Energy-Buyback-Scheme
  and acknowledging and confirm the matters set out in that application.
Please upload a copy of your Synergy Bill here:*
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Signature:*

Consent Form

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