AnAAn initit attivivee ee ee of the Nata ionaanal l ElEElectrtriccalaal

Connecting you to a more sustainable future
An ini
An
nititit attiv
ivee of tthe
he Nat
Na io
iona
naal Elec
nal
Elec
El
ectr
tric
tr
iccal
al and
n Com
ommu
muni
muni
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nica
catitition
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onns As
Asso
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at
Enhancing
your business.
Advancing
our industry.
Application
for
EcoSmart Electricians Accreditation
I/We, the undersigned, hereby apply for EcoSmart Electricians Accreditation.
Legal Name of Business:
Trading Name: (if applicable)
ACN:
ABN:
Electrical Contractor Registration/Licence Number:
Expiry Date:
State/Territory of Issue:
Business Address
Suburb:
State:
Post Code:
State:
Post Code:
Postal Add
ddress (If didifffferent to business
i
address)
Suburb:
Telephone:
Facsimile:
Mobile:
Emai
Em
aill Address:
Website:
Name of Proppri
r etors, Partners, Directors
1.
2.
3.
Contact person for the purposes of EcoSmart Electricians
Name:
Position:
Phone:
Email:
Are you a NECA member?
Yes
State/Territory of membership:
No
NECA membership Number:
Empl
ploy
oyeee det
etai
ails
ls
Total number of licensed electricians employed
Names of licensed electricians who have undertaken the EcoSmart El
E ectricians trainin
i g and receeiv
ived Energy Efficienccy Certtifi
i cation
Full Name
Organisation/RTO providing
ng ttra
rainingg*
* leas
*P
leeas
asee pprrov
ovid
idde ev
evid
iidden
e cee tha
h t th
t e tr
t aini
ainingg was succe
ai
uccess
uc
ceesssfuully
llly ccoompple
lete
ted iiff the
te
he tra
rain
inninng wa
inin
w s no
nott ddeeliive
vere
redd by
re
b NEC
E A.
A
Do you want to be added to the publicly available list of accredited EcoSmart Electricians?
You are eligible to be included in the list of accredited EcoSmart Electricians. This list is made available to the public by NECA including on the Ecosmart
Electricians website. If you would like to be included in this list please indicate below. Your details will only be added to the
EcoSmart Electricians list upon receipt of your consent.
Please note that your details can be altered, added or removed from the list at any time by contacting; [email protected]
Do you want to be added to the publicly available list of accredited EcoSmart Electricians?
Yes
No
NECA collects your personal information for the purpose of administering the Ecosmart Electricians accreditation program. We only disclose your
personal information with your consent or if it is necessary for the performance of our functions. If you wish to seek access to the personal information
which NECA holds about you please contact us by writing to NECA.
Level 12,
12 222 Kingsway,
Kingsway South Melbourne 3205 or email ecosmart@neca
[email protected].
asn au
NECA’s privacy policy is available on [email protected]
Please complete and sign the code of conduct
I/We certify and agree to the following clauses:
• That all of th
the abov
ovee mentioned information is truue and correct; and
• Th
That
at as a condition of acceptance of this application, agree, if approved for accreditation, to adhere to and be bound by the current EcoSma
mart
rt
Electricians Code of Conduct, which may be modified or varied in any extent in the future; and
• That in the event of accreditation being withdrawn or upon resignation, agree to
(a) not use any Ecosmart Electricians stationery and literature, etc
(b)) re
(b
remove allll logos, devices
i andd insigni
i ia’’s from
f
vehhiclles, shop
h wiinddows or othe
h r places
l
th
that could
ld give a misleadding impression to ot
othe
h rs that I/We
are still accredited EcoSmart Electricians.
(c) nott ad
adve
vertise or otherwise hold out that I/we are accredited EcoSmart Electricians
Sign
gnat
atur
ure
Date
Name of Signatory
Position
/
/
Payment details
Payable amount: $
Payment Type:
Visa
MasterCard
BankCard
Cheque or Money Order made payable to NECA
Creditt C
Caard No:
Cardholder Name:
Expiry Date:
C rdholder signature:
Ca
/
Agreement to uphold the Accredited EcoSmart Electricians
Code of Conduct
The following must be signed prior to seeking accreditation as an Accredited EcoSmart Electrician and forwarded to NECA at the address below.
Please keep a copy of this signed agreement with the Code of Conduct for your records.
I hereby agree to the terms of the Code of Conduct for Accredited EcoSmart Electricians
Siggnat
Si
ature
Date
/
Name of Signatory
Company Name
/
ABN
Offic
Of
fi e Us
fic
Usee On
O lyy
A crreddittat
Ac
a ioon Nu
N m
mbber
e
D te of Acccrred
Da
editittattioon
/
/
EcoS
Ec
oSmart
maarrtt Ele
m
leccttrriici
cian
ans
LLeeve
vel 1122, 222
22222 King
King
Ki
ngsw
sway
ay
Souutth M
So
Meelbbourn
oouurrnne VIIC
C 33220055
TTeele
ele
lepphhoonnee:: 11330000 30000 03311
EEm
m
maai
aill::
eeccos
osma
mart
arrttt@n
@nneecccaaa..as
@
.aassn.
n.aauu
Websit
We
bbssititee:: ww
www
w..ec
ecoossm
maarrtttel
eleeccttrric
el
iciiaans
ns.c
.com
om.aau
Enhancing
your business.
Advancing
our industry.