Fillable Gas supply disconnection form (London Institute of Management and Technology)

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Gas supply disconnection form (London Institute of Management and Technology)

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U.K. forms for London Institute of Management and Technology

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Meter point reference number (MPRN) number(s)
(this can be found on your gas bill)
Please note we need your MPRN number to
proceed. Your request may be delayed without it
Name
Organisation
Address
Postcode
Name
Organisation
Address
Postcode
Gas supply disconnection form
1. Site address / site contact
2. Customer details / correspondence address
(if dierent to site address)
3. Details about this disconnection (please tick circles where appropriate)
For oce use only: Job ref number
If you ask for your property’s gas supply to be disconnected, you must make sure that the meter has been removed
before the disconnection is carried out. You’ll need to contact your gas supplier to do this. If you don’t know who
your supplier is, please contact 0870 608 1524 (this service is provided by National Grid and calls to this number will
cost £0.07 per minute plus your phone company’s access charge). If you don’t do this, you could be charged for an
abortive visit and the work not being carried out on the date you asked for. This disconnection is permanent, and any
reconnection would be treated as a new supply request.
Is this a single or multiple disconnection?
Single
Multiple
If this is a multiple disconnection, please give
details of the addresses and number of properties
(use separate sheet if necessary)
Telephone
Mobile
Email
Telephone
Mobile
Email
Page 1 SGN038N (11/2015)
SGN is a brand name of Scotland Gas Networks plc
Registered in Scotland No. SC264065
Registered Oce: Axis House | 5 Lonehead Drive | Newbridge | Edinburgh EH28 8TG
SGN is a brand name of Southern Gas Networks plc
Registered in England & Wales No. 05167021
Registered Oce: St Lawrence House | Station Approach | Horley | Surrey RH6 9HJ
5. Please give an indication of when the disconnection will be needed
6. Please give us any other information which you feel may be relevant
if possible please provide a map indicating the site and existing meter location(s)
4. Please give the reason for your request
eg demolition, gas no longer required etc – this information will help us to process your request
Do you wish to receive your quote via email?
Yes
No
I certify that the information given is correct to the best of my knowledge
Please email your completed application form to admindesk@sgn.co.uk or post it to:
Signed
Name (printed) Date
SGN Connections
Axis House | 5 Lonehead Drive
Newbridge | Edinburgh EH28 8TG
If you have any queries with this form please contact our Customer Service team on 0800 912 1700
or email customer@sgn.co.uk
Please note that SGN Connections Limited is acting as the agent of Scotland Gas Networks plc and Southern Gas
Networks plc and your contract will be with Scotland Gas Networks plc (if the works are being carried out in Scotland)
or Southern Gas Networks plc (if the works are being carried out in England) in accordance with the Siteworks terms
and conditions published on our website at sgn.co.uk
Page 2 SGN038N (11/2015)
SGN is a brand name of Scotland Gas Networks plc
Registered in Scotland No. SC264065
Registered Oce: Axis House | 5 Lonehead Drive | Newbridge | Edinburgh EH28 8TG
SGN is a brand name of Southern Gas Networks plc
Registered in England & Wales No. 05167021
Registered Oce: St Lawrence House | Station Approach | Horley | Surrey RH6 9HJ
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Gas supply disconnection form (London Institute of Management and Technology)

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Completed 21 April 2021

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