Contact and Personal Information Form

Please complete the form below, you should receive a success message and a confirmation email after you have completed and submitted the form.

THE REFERENCE NUMBER IS A 4 DIGIT NUMBER THAT WAS ISSUED TO YOU VIA TEXT MESSAGE. YOU MUST INCLUDE THE CORRECT REFERENCE NUMBER TO HAVE YOUR DETAILS UPDATED AND BE ENTERED INTO THE DRAW.

Safe Electric Service Complaint

"*" indicates required fields

Address of Registered Electrical Contractor
DD slash MM slash YYYY
Max. file size: 146 MB.
This field is hidden when viewing the form
Please note that by submitting this form you agree that any relevant parties may receive a copy of this complaint
This field is for validation purposes and should be left unchanged.