CustomerDefect

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Title

Given name *

Surname *

Street address *

Suburb *

State *

Postcode *

Email address *

Network protection number *

Date defect rectified *

Licenced electrician name *

Description of works carried out *

Upload file (8 MB file upload size limit)

Attachment can be an Office document, PDF or image.

I certify that the defect described in the network protection notice has been rectified in accordance with Regulation xyz.

I confirm that the information provided in this form is true, complete and accurate.