Nomination Form Template Corporation – Energy Saver nomination (Part A) To be completed by the original Energy (ie Purchaser) making the nomination Original Energy Saver details Corporation name ABN Implementation address Postal address Phone number Past activities Have you signed a nomination form for the energy savings arising from this activity in the past? (If yes, please provide a reason for the amended nomination form.) Is the site a residential building or small business building? Please select the activities that will be undertaken at the site D1 Replace an external single-glazed window or door with a thermally efficient window or door D2 Modify an external window or glazed door by installing secondary glazing D3 Replace an existing air conditioner with a high efficiency air conditioner D4 Install a high efficiency air conditioner D5 Replace an existing pool pump with a high efficiency pool pump D10 Replace an existing electric water heater with a high efficiency gas fired water heater D11 Replace an existing gas fired water heater with a high efficiency gas fired water heater D12 Install a high efficiency gas heater or replace an existing gas space heater with a high efficiency gas space heater E1 Replace halogen downlight with an LED luminaire and/or lamp E2 Replace a linear halogen floodlight with a high efficiency lamp E3 Replace parabolic aluminised reflector (PAR) lamp with efficient luminaire and/or lamp E4 Replace a T8 or T12 luminaire with a T5 luminaire
Nomination Form Template – Corporation Energy Saver nomination (Part A) To be completed by the original Energy (ie Purchaser) making the nomination Original Energy Saver details Corporation name ABN Implementation address Postal address Phone number Past activities Have you signed a nomination form for the energy savings arising from this activity in the past? (If yes, please provide a reason for the amended nomination form.) Is the site a residential building or small business building? Please select the activities that will be undertaken at the site D1 Replace an external single-glazed window or door with a thermally efficient window or door D2 Modify an external window or glazed door by installing secondary glazing D3 Replace an existing air conditioner with a high efficiency air conditioner D4 Install a high efficiency air conditioner D5 Replace an existing pool pump with a high efficiency pool pump D10 Replace an existing electric water heater with a high efficiency gas fired water heater D11 Replace an existing gas fired water heater with a high efficiency gas fired water heater D12 Install a high efficiency gas heater or replace an existing gas space heater with a high efficiency gas space heater E1 Replace halogen downlight with an LED luminaire and/or lamp E2 Replace a linear halogen floodlight with a high efficiency lamp E3 Replace parabolic aluminised reflector (PAR) lamp with efficient luminaire and/or lamp E4 Replace a T8 or T12 luminaire with a T5 luminaire
Nomination_Form_Template_-_HEER_V20.docx