Formulaire IN ENG - Sibelga

BRUSSELS-CAPITAL
REGION
What is the purpose of this form?
Use this form to note the details you have to give to your electricity and/or natural gas supplier
when you move to your new address. Send these details to your supplier by telephone, fax, post
or via the website within one week of having received the keys to your new home.
Filling in and sending this form is not sufficient to settle your change of address: you first need to
have a supply contract with the supplier of your choice or with the default supplier.
Identification of the new occupant
Private individual or self-employed person Surname and first name
Company Company name Company number
Tel. Mobile phone
(during office hours)
Supplier(s) natural gas
electricity
Customer number(s) natural gas
Your new address
electricity
street No box
postcode commune
Removal date
This is the date from when you use energy at your new address. As of this date, you therefore have to pay for the
electricity and natural gas you use.
date: day month year
Billing address
To be completed only if your bills should not be sent to your new address.
street No box
postcode commune
Electricity supply point
Administrative details
You will find the EAN code of the electricity supply point at your new address on the electricity bills sent to the previous
occupant. You can also obtain this code from Sibelga, your distribution network operator, by calling 02 549 41 00. The
EAN code consists of eighteen figures:
EAN code of the electricity supply point
EAN code of the electricity supply point
night-time only (if available)
CHANGE OF ADDRESS
FORM FOR NEW OCCUPANT
5 4 1 4 4
5 4 1 4 4
Tick if applicable:
The electricity meter at my new address is not (yet) in use.
Upon receiving a signal from my supplier, I will contact Sibelga (02 549 41 00) to make an appointment with a
technician who will come and open my meter.
SEE OVER-
LEAF

Meter reading
When reading the meter, only enter the figures in front of the comma. Note down the information on night-time
consumption for the dual hourly rate meter and the meter for night-time consumption only if these meters are
present. If you do not send your supplier the data on this form within a week after the removal date, the company
that reads your meter will estimate the reading. This estimated meter reading will then be the initial meter
reading for the billing of your future consumption.
Meter type Meter number Meter reading
Meter daytime consumption
Meter night-time consumption
(with dual hourly rate)
Meter night-time consumption only
Natural gas supply point
Fill in the data on natural gas if you have a natural gas connection.
Administrative details
You will find the EAN code of the natural gas supply point at your new address on the natural gas bills sent to the
previous occupant. You can also obtain this code from Sibelga, your distribution network operator, by calling
02 549 41 00.The EAN code consists of eighteen figures:
EAN code of the natural gas supply point 5 4 1 4 4
Tick if applicable:
The natural gas meter at my new address is not (yet) in use.
Upon receiving a signal from my supplier, I will contact Sibelga (02 549 41 00) to make an appointment with a
technician who will come and open my meter.
Meter reading
When reading the meter, only enter the figures in front of the comma.
If you do not send your supplier the data on this form within a week after the removal date, the company that reads
your meter will estimate the reading. This estimated meter reading will then be the initial meter reading for the
billing of your future consumption.
Meter type Meter number Meter reading
Natural gas meter
Signature of the new occupant
Surname and first name
I confirm that the information on this form is
correct and that I will send it to my supplier as
soon as possible.
Signature
FORM FOR NEW OCCUPANT (cont.)
Signature of the previous occupant
or of the owner
Surname and first name
Tick as appropriate:
Previous occupant
Owner
I confirm that the information on this form is
correct and that I will send it to my supplier as
soon as possible.
Signature