ELT Application Sponsorship Form
Commercial Lighting Energy Savings Formula
Purpose of this form
This checklist is used when submitting an application for acceptance of an emerging lighting
technology (ELT) product in the Energy Savings Scheme (ESS). It must be used by
non-ACPs to confirm that the products have been sponsored by at least two ACPs for use in
the ESS. This form does not need to be completed when the ELT product application is
being submitted by an ACP.
Refer to the ELT webpage and Lighting Equipment Requirements guide for assistance in
preparing the application documentation. The application information must be consistent
with, and meet the requirements set out in, these documents.
Meaning of key terms and icons in this form
Key terms
ACP means accredited certificate provider. At least two ACPs must confirm that the ELT
application relates to products that are intended to be installed as part of an ESS lighting
upgrade.
ELT means emerging lighting technology. ELTs must be accepted by the ESS Scheme
Administrator as meeting the relevant equipment requirements.
Non-ACP means persons other than Accredited Certificate Providers (ACPs). Non-ACPs
include businesses that manufacture, supply or distribute lighting equipment in NSW for the
purposes of use in lighting upgrades under the ESS.
Icons
Important information to assist you with completing the application.
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How to complete and submit an application
1.
Complete one sponsorship form for each ACP that is sponsoring the products. You may
include more than one product on a sponsorship form.
2.
Submit the two sponsorship forms and supporting documentation to IPART.
–
Applications made through the ELT Portal (ie, via the standard pathway) must have
two signed sponsorship forms uploaded in Step 6 “Other Documents” of the ELT
Portal submission wizard.
–
Applications made via the VEET pathway, must have the two signed sponsorship
forms attached to the email application.
Applicant and product details
1. Applicant (non-ACP) details
Provide details for the non-ACP organisation applying for ELT product acceptance and its contact.
Applicant (company) name:
<Type details>
Contact name:
<Type details>
Contact email:
<Type details>
2. Details of ELT products being sponsored
All products in a series application must be included on one sponsorship form. One form may cover multiple
applications, but there is a limit of 15 products per form.
Brand Name
Model Number
1
<Brand Name>
<Model Number>
2
<Brand Name>
<Model Number>
3
<Brand Name>
<Model Number>
4
<Brand Name>
<Model Number>
5
<Brand Name>
<Model Number>
6
<Brand Name>
<Model Number>
7
<Brand Name>
<Model Number>
8
<Brand Name>
<Model Number>
9
<Brand Name>
<Model Number>
10
<Brand Name>
<Model Number>
11
<Brand Name>
<Model Number>
12
<Brand Name>
<Model Number>
13
<Brand Name>
<Model Number>
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Brand Name
Model Number
14
<Brand Name>
<Model Number>
15
<Brand Name>
<Model Number>
ACP declaration
3. Sign the declaration for this sponsorship
Section 158 of the Electricity Supply Act 1995 imposes a maximum penalty of $11,000 and/or six (6) months
imprisonment for knowingly providing false or misleading information to the Scheme Administrator.
Section 138 of the Electricity Supply Act 1995 imposes a maximum penalty of $220,000 for failure to comply
with a condition of accreditation and may additionally result in the suspension or cancellation of the
Accredited Certificate Provider’s accreditation under clause 42 of the Electricity Supply (General) Regulation
2014.
I hereby declare that:

I am an authorised signatory of the Accredited Certificate Provider named above.

The Accredited Certificate Provider named above intends to use the products listed in section 4
of this form in a lighting upgrade under the Energy Savings Scheme.

The information contained in this form is complete, true and correct and not misleading by
inclusion or omission.

I authorise IPART to copy, record, use or disclose any of the information provided in this
application for the purpose of assessing and making a decision on the application, auditing,
compliance, and enforcement of laws, regulation and legislative rule, the performance of
IPART’s statutory functions and for related purposes, subject to requirements of relevant laws.

I confirm that IPART may contact the administrator of any government scheme or program to
obtain information on our products and performance in that scheme or program, and I
understand that information will form part of the ESS application assessment.

I am aware that there are penalties for providing false or misleading information to IPART as
Scheme Administrator of the Energy Savings Scheme.
Signed by or on behalf of the ACP:
Signature of authorised signatory:
ACP (company) name:
Full name of signatory:
Position/title of signatory:
Date signed:
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