Please write in BLOCK Letters.

1. PAYMENT TYPE I have received a $______________Point of Sale Discount. Please pay the Builder/Agent/Dealer
Please pay me, the owner of the installation.
2. SYSTEM OWNER DETAILS
Suburb/Town State Postcode
Home Work Mobile
3. INSTALLATION DETAILS
Installation Address
Lot/Unit Number Street Number Street Name Street Type
Suburb/Town State Postcode
V I C
VEEC Category
1A. Decommission Electric & Install Gas Storage 1E. Decommision Electric & Install Solar (Electric Boost)
1B. Decommision Electric & Install Gas Instananeous 1F. Decommission Electric &Install Solar (Gas Boost)
1E. Decommission Electric & Install Heat Pump 3B. Decommision Gas & install Solar (Gas Boost)
Yes No Was the decommissioned unit removed from the site?
Number of VEECs For help calculating the number of VEECS go to www.esc.vic.gov.au
Installation Date Yes No
Installation Details Compliance Certificate Number Electical Safety Certificate Number
Brand Installed Rheem Vulcan Everhot Solahart AquaMax Edwards Sunheat
System Model Number
Model Number Tank Serial Number
Small ( 120 L )* Large ( > 120 L )**
* Small: If estimated the household is using 120 litres or less of hot water per day. ** Large: If estimated the household is using more than 120 litres of hot water per day.
Type & Number of Solar Panels Installed
Number of solar panels
Solar Panel Serial Numbers Collector #1

Collector #2
Collector #3 Collector #4
Gas Continuous Flow / Booster Details
Model Number Serial Number
4. INSTALLER DETAILS
Business Name
First Name Surname
Postal Address
SUBURB/TOWN STATE POSTCODE
Contact Numbers
PHONE MOBILE FAX NUMBER
Plumber's Licence Number Electrician's Licence Number
Have you completed Solar Hot Water Installation Training? No Yes If so, by whom _______________________
5. PAYMENT DETAILS
Page 1 of 2
Victorian Energy Efficiency Certificate (VEEC) Assignment Form
Important: Ensure you enter the correct BSB & Account Number.
They can be found on your bank statement. It IS NOT the 16 digit
number on your credit/debit card. Rheem will only use your bank
details to pay the financial benefit of this VEEC Assignment.
Was a new gas connection made at the site?
Other
Phone Numbers
Qualifications:
Postal Address
First Name Surname
Aquamax S Type
Jun 2014
Account Name
Email (for payment
notification to be sent)
BT
Australis Series 2 Titan Series 2A
KF
BSB
T200 S200
System Size
VEECS can only be claimed when REPLACING a Gas or Electric Water Heater in an EXISTING residential property.
PLEASE SIGN THE DECLARATIONS ON PAGE 2
Account Number
LCS J L
Tank Details
HBT200 NPT200
Version 4 February, 2010
6. DECLARATION BY THE INSTALLER
I hereby declare that:-
1. I am licensed, and have been trained to install the system detailed on this form.
2. I have public liability insurance of at least $5 million.
3. The new system has been installed in a residential premises and meets its intended purpose.
4. The new system has REPLACED an Electric or Gas Water Heater.
5. The details of the decommissioned water heater are:



6. The Water Heater was decommissioned as described in the Compliance Certificate.
7. The decommissioned Water Heater was disposed of in the following way OR was not removed from the site for the following reason



8. The installation meets all relevant standards, building codes and local council requirements.
9. 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.
10. I understand my obligations under the VEET Legislation and all activities with respect to this installation have been
undertaken in accordance with this Legislation. I will also, as necessary, full y co-operate with Rheem Australia Pty Ltd ABN
21 098 823 511 (the accredited person) to resolve any errors or omissions associated with this VEEC Assignment Form.



7. DECLARATION BY THE CUSTOMER
I hereby declare that:-
1. I am the tenant / landlord / owner (delete as appropriate) of the residence at the above installation address
2. The information provided by the installer is correct and complete.
a. I have / have not (delete as appropriate) received a compliance certificate for the work
b. I have / have not (delete as appropriate) received a certificate of electrical safety for the work
3. I understand that by signing this form I am assigning the right to create certificates for this system to Rheem Australia Pty Ltd ABN 21
098 823 511 (the accredited person) and in return, have received/will receive an identifiable benefit from Rheem for doing so.
4. I have not previously created VEECs or assigned my right to create VEECs to another registered Agent for this installation.
5. I understand the information on this form will be disclosed to the Essential Services Commission for the purpose of creating VEECs
under the Victorian Energy Efficiency Target Act 2007 and for related verification, audit and scheme monitoring purposes.
6. The Essential Services Commission has the right to inspect the installed system with reasonable notice.
7. I am aware that penalties can be applied for providing misleading information in this form under the Victorian Energy Efficiency Target
Act 2007.



Useful Information:
A VEEC represents a reduction of one tonne of carbon dioxide equivalent and can be created by the consumer when inefficient water
heaters are decommissioned and replaced with eligible water heaters. To find out how many VEECS your installation is eligible for,
go to www.esc.vic.gov.au. Please note that VEECs are not applicable to new homes or commercial installations.
The consumer can assign their right to create VEECS to a registered person such as Rheem Australia Pty Ltd in exchange for
financial benefit. It is the consumers responsibility to negotiate satisfactory terms. You are not obliged to assign your right to create
VEECs to Rheem. If you choose to do so, you will receive the financial benefit either by Point of Sale Discount or after the VEECs
have been created. The value of a VEEC will change depending on market suppl y and demand. Rheem will pay our current
rate on the day we receive the form. To find out the current value of VEECs you can call us on 132 552. To allow sufficient
processing time, all claims must be received by 31
st
May in the year after installation.
Rheem will only use the information on this form to create VEECS. For further information regarding privacy go to
www.privacy.vic.gov.au









Attachment Checklist
Incomplete applications will be returned without processing. Please ensure you attach:
Proof of Purchase (this is the invoice from the installer/agent to the customer).
This must clearly show any point of sale discounts (if given).
A Copy of your Compliance Certificate which also describes how the Water Heater (unit type, make and model) was
decommissioned and disposed of.
A Copy of your Electrical Safety Certificate (this is optional but sending it will speed up processing time)
An Invoice for the VEECs financial benefit (only if the payment is to be made to a business). The invoice should be
made out to Rheem Australia Pty Ltd and must show your ABN. If you are charging GST this should be a tax invoice.
To claim your benefit send form and attachments to:
Post: Email: Fax:
Rheem Australia Pty Ltd veec@rheem.com.au (02) 9684 9284
VEEC Administration
PO Box 6, Rydalmere, NSW, 2116

Page 2 of 2 Jun 2014
Type ( eg Gas or Electric): Model & Approximate Age: Date of Decommissioning:

Installers Name: Installers Signature: Date:
Customers Name Customers Signature Date