National Grid Bill Dispute Form – Fill Out and Use This PDF

DATE: ______________

FINAL BILL DISPUTE INSTRUCTIONS

Recently, you contacted us requesting a review of a dispute you may have with National Grid. In an effort to facilitate the resolution of your dispute, please complete the applicable portion of this form.

Collection efforts on this disputed account will be suspended for up to fifteen (15) days. However, if we do not receive the necessary information from you, or your information is not complete within the fifteen

(15)days, collection efforts will resume on the disputed amount. If we do not hear from you within the fifteen (15) days, we will assume that you do not wish to pursue this matter, and will consider your dispute inquiry closed.

National Grid will notify you in writing of the final results of your dispute.

ALL QUESTIONS PERTAINING TO YOUR DISPUTE MUST BE ANSWERED AND ALL DOCUMENTS THAT SUPPORT YOUR CLAIM MUST BE ATTACHED TO THIS FORM.

Account number: _____________________________________________________________________

Amount in dispute: $___________________________________________________________________

Is this disputed information listed on your credit report? Yes No Unknown

Your name: __________________________________________________________________________

Current address: ______________________________________________________________________

Current mailing address, if different: _______________________________________________________

How long have you been at this address? __________________________________________________

Current phone number: _________________________________________________________________

Your social security number: ____________________________________________________________

(While not required, if you do not provide your social security number, you must submit two (2) alternate forms of identification. (See Page 5)

Previous address: _____________________________________________________________________

From: ______________________ To: _______________________

Previous address: _____________________________________________________________________

From: ______________________ To: _______________________

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National Grid has outlined several possible reasons for which a customer may be disputing a bill. Please check all that pertain to your claim and follow the directions for that section; you may choose more than one.

You are claiming that someone used your name and social security number without your permission. Please fill out all questions and provide the proper documentation requested in Section I – FRAUD and/or Section 1A Minor, on page 3 of this packet.

You are claiming that you were billed beyond the dates that you resided at or owned the property. Please fill out all questions and provide proper documentation requested in Section II – BILLING DATES, on page 4 of this packet.

You are claiming that you have already paid the debt. Please fill out all questions and provide proper documentation requested in Section III - BILL PAID, on page 4 of this packet.

Additional Comments/Explanations:

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SECTION I - FRAUD

In order to process your dispute for SECTION I – FRAUD you will be required to answer all the questions in this section and send in the following documents:

Acceptable Proof of Residency is required (page 5)

A copy of a Police Report is required (page 5)

If obtainable, a Statement of Responsibility can be sent in for this section (page 5)

1.What is the address you are disputing? (house number, street, city, zip code)

_____________________________________________________________________________

2.	Did you ever live at the disputed address?	Yes	No
3.	Do you know who lived there during the disputed dates?	Yes	No

If Yes, Who: ___________________________________________________________________

4.Where were you living during the disputed time frame? (house number, street, city, zip code)

_____________________________________________________________________________

5.Did you have National Grid services in your name at the time of this dispute?

Yes No

If Yes, at what address? (house number, street, city, zip code)

_____________________________________________________________________________

SECTION IA – MINOR

In order to process your dispute for SECTION IA – MINOR you will be required to answer all questions in this section and send in the following documents:

A copy of a Police Report is required (page 5)

A copy of your Birth Certificate is required

If obtainable, a Statement of Responsibility can be sent in for this section (page 5)

1.What is the address you are disputing? (house number, street, city, zip code)

___________________________________________________________________________________

2.	Did you ever live at the disputed address?	Yes	No
3.	Do you know who lived there during the disputed dates? Yes		No

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If yes, who: __________________________________ Relationship________________________

4.Date of Birth: (Month/Day/Year) ______________________________________________

SECTION II – BILLING DATES

In order to process your dispute for SECTION II – BILLING DATES you will be required to answer all questions in this section and send in the following documents:

Acceptable Proof of Residency is required. (See page 5)

1.What is the address you are disputing? (house number, street, city, zip code)

_______________________________________________________________________________

2.What dates did you reside at or own the disputed address?

From _________________________________ To _____________________________________

3.Did you call National Grid to disconnect service? If so, on what date did you call to have services disconnected at the disputed address? (Month/Day/Year).

_________________________________________________________________________________

4.What telephone number did you call from to request disconnection of service? (Please include area code).

___________________________________________________________________________________

5.At the time of your disconnect, did you request a connect for new services at another National Grid address?

Yes No

If yes, at what address? (house number, street, city, zip code)

_________________________________________________________________________________________

SECTION III – BILL PAID

In order to process your dispute for SECTION III – BILL PAID you will be required to answer all questions in this section and send in the following documents:

A copy of the Cancelled Check is required (see page 5)

1.What is the address you are disputing? (house number, street, city, zip code)

_______________________________________________________________________________

2.Please tell us where, when, and to whom the payment was made.

_____________________________________________________________________________

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ADDITIONAL DOCUMENTATION

Throughout this packet additional documentation to support your dispute may be required. Here is a list of acceptable documentation and brief descriptions:

PROOF OF RESIDENCY for the disputed address or for the residence at which you actually resided during the disputed time frame.

Acceptable forms of Residency include:

Lease

Deed

Bill of Sale

Notarized landlord statement (requires signature of Landlord)

Recent mortgage statement

Utility/Auto Insurance bills

Vehicle/Voter Registration

FORMS OF IDENTIFICATION 2 forms of identification are needed IF you do not provide us with your social security number.

Acceptable alternate forms of identification include:

Driver’s License

Sheriff’s Card

Passport

Work Stub

Benefits card for DSS

Social Security Card

Military ID

Student ID

Birth Certificate

Green Card

POLICE REPORT This is obtained by contacting your local police department and explaining all the facts of your suspected criminal impersonation. In the summary of the police report National Grid must be listed as a claimant as well as the amount in dispute and the person you suspect may have used your name illegally. You must be prepared to prosecute the person who fraudulently obtained service in your name to the fullest extent of the law.

STATEMENT OF RESPONSIBILITY This statement must be provided by the person who is actually

responsible for your bill. The statement must include their full name, their social security number, current mailing address and current phone number. This statement must include the responsible person’s notarized signature.

PROOF OF INCARCERATION This document must be official incarceration papers and must include the date incarcerated and the date of release.

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CANCELLED CHECK, a copy of the front and the back of the cashed check used for payment of your account IS required.

PLEASE RETURN THIS PACKET AND ALL REQUIRED DOCUMENTS WITHIN FIFTEEN

(15) DAYS TO:

National Grid

PO Box 960

Northborough MA 01532-0960

ATTN: Final Bill Recovery Group

OR, you may FAX your documents TO: (508) 357-4730.

National Grid appreciates your interest in resolving this mutual area of concern and looks forward to serving your energy needs in the future.

By signing below I acknowledge that all of the above information is true to the best of my knowledge.

________________________________________________	_____________________________
Your Signature	Date

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