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Application QGA
Step 1
Customer Details
Step 2
Application Details
Step 3
Specifications
Step 4
Checklist
Customer Name
*
If company - put company name here
Company ABN
Contact Name
*
Authorised Person Making this Application
*
Phone
*
Email
*
Installation Address
*
Installation Suburb
*
Installation Address Postcode
*
Location Address
*
As Above
Location Suburb
*
Location Postcode
*
Billing Address
*
As Above
Billing Suburb
*
Billing Postcode
*
Billing State
*
[ select ]
Queensland
New South Wales
Victoria
South Australia
Western Australia
Tasmania
Northern Territory
Australian Capital Territory
Referring Gas Fitter Details
Name of Company
Contact Person
Phone
Appliance Type
*
[ select ]
Air Conditioning Units
Appliance Pressure Regulators
Caravan Appliance
Commercial-Fryers
Commercial-Grill/Griddle
Commercial-Hot Water/Steam
Commercial-Other
Commercial-Oven
Commercial-Ranges
Decorative Appliances
Domestic Cooking appliances
Ducted air-heaters
LPG portable & mobile appliances
Outdoor Barbeque Grillers
Refrigerators
Space Heating Appliances
Swimming Pool and Spa Pool Heaters
Water Heaters
Laundry Dryers
Appliance Age
*
[ select ]
New
Second Hand
Description of Appliance
*
Manufacturer
*
if unknown, please type unknown
Make
*
if unknown, please type unknown
Model
*
if unknown, please type unknown
Serial Number
*
if unknown, please type unknown
Caravan/Marine/Food Van
Mobile Vehicle Type
[ select ]
Caravan
RV
Yacht
Mobile Food Van
Other
Make
Model
Is the Vehicle Second or imported?
Yes
No
VIN
Year
Gas Consumption
*
if unknown, please type unknown
Injector Size/s
*
if unknown, please type unknown
Gas Types
[ select ]
Propane
Natural
Universal LP
Installation Instructions Supplied?
*
Yes
No
if yes - please upload below
Has the Appliance Been Installed?
*
Yes
No
Specifications Supplied?
*
Yes
No
if yes - please upload below
Country of Origin
*
if unknown, please type unknown
Copy of Manual Supplied with Application?
*
Yes
No
if yes - please upload below
Nameplate on Unit?
*
Yes
No
Supporting Documentation
File must be one of the following types
pdf,doc,docx,jpeg,jpg
and
Be less then
4.88 Mb
Please upload any support documentation
Is the equipment a Domestic or Commercial Type A Gas Appliance?
*
Yes
No
The appliance has the correct jets for the gas type it is operating
*
Yes
No
There is gas available to test the appliance
*
Yes
No
The appliance will not be used in the absence of a Gas Safety Approval
*
Yes
No
A gas fitter has been contacted to assist in connecting the appliance
*
Yes
No
The appliance has a name badge on the equipment listing Model number, serial number, manufacturer, gas type, injector sizes, gas pressure and mega joule rating
*
Yes
No
If the unit has electrics, a full diagram and name plate has been supplied
*
Yes
No
N/A
The technical and operational manual for the unit has been supplied
*
Yes
No
The unit is gas tight and safe to operate
*
Yes
No
The unit will be in an operating situation to assist the process
*
Yes
No
A digital photo of the unit has been supplied
*
Yes
No
Terms
*
I Agree to the below conditions:
I hereby certify that the above appliance meets the safety requirements for gas devices (Type A)
As detailed under s733 of the Petroleum and Gas (Production and Safety ) Act 2004
All Type A gas devices must be approved before they may be supplied, installed or used.
The information provided in this application is true and accurate.
I understand there is a $165.00 non-refundable application fee
I acknowledge that this application will require 3-5 business days for the review and approval of this application.
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