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Customer Protections Form

Please select the protection you are looking to apply for from the options below. For each protection you will be required to submit the relevant documentation for proof. If you are NOT on the low-income Discount Rate you will also have to submit your Financial Hardship statement below.
Please enter a valid value in the format of 12345-67890
Please enter a valid value in the format of 12345-67890
Important Notice! By selecting email you are opting to receive electronic communication from National Grid only for this protections application information, we will not use this email to contact you for other purposes unless you have opted in elsewhere.
Elderly/Elderly w Minor Protections

Please Provide Proof from One of The Following for Each Household Member:
 • Driver’s License    • Military ID    • Birth Certificate    • Marriage License    • Passport
File extensions allowed include: .jpg, .jpeg, .png, .tif, .pdf
File extensions allowed include: .jpg, .jpeg, .png, .tif, .pdf
File extensions allowed include: .jpg, .jpeg, .png, .tif, .pdf
File extensions allowed include: .jpg, .jpeg, .png, .tif, .pdf
File extensions allowed include: .jpg, .jpeg, .png, .tif, .pdf
File extensions allowed include: .jpg, .jpeg, .png, .tif, .pdf
File extensions allowed include: .jpg, .jpeg, .png, .tif, .pdf
Medical Protections
Medical Protection - A household qualifies for a serious illness protection when a doctor or licensed medical professional confirms a patient with a serious or chronic illness resides in that household. Proof required must be on Medical Professionals Letterhead, include a signature (or e-signature) of a Doctor (MD), Nurse Practitioner (NP), Physicians Assistant (PA), or local Board of Health signature. It must state the name and address of seriously ill person and whether the illness is serious (90 day protection) or chronic (180 day protection). 

File extensions allowed include: .jpg, .jpeg, .png, .tif, .pdf
File extensions allowed include: .jpg, .jpeg, .png, .tif, .pdf
Infant Protections
Infant Protections -  A household qualified for Infant protection when a child under 12 months of age resides in the household.  A valid birth certificate or a letter or official documents issued by a registered physician, physicians assistant, nurse practitioner, local board of health, hospital or government official, Dept of Transitional Assistance, clergyman, or Religious institution is required to qualify. 

File extensions allowed include: .jpg, .jpeg, .png, .tif, .pdf
File extensions allowed include: .jpg, .jpeg, .png, .tif, .pdf
File extensions allowed include: .jpg, .jpeg, .png, .tif, .pdf
File extensions allowed include: .jpg, .jpeg, .png, .tif, .pdf
File extensions allowed include: .jpg, .jpeg, .png, .tif, .pdf
Financial Hardship Form
Please indicate below whether your National Grid Account is on a Low-Income Discount Rate. If you are NOT on the low-income rate you're required to fill out the Financial Hardship statement below. If you are unsure select no and fill out the following form to ensure quick processing time for your protection claim.

Please list ALL people living in your household (including children). If they receive income, list the income source, amount and when received. (Click the Add Addition Person link below to list additional people.)
Household Person Information
Household Person Information
Household Person Information
Household Person Information

Third Party Information 
The Third Party program allows you to select a person to act on your behalf if you receive a collection notice from us. We will send a copy of any collection notice to your third party who can look into the situation and help make arrangements. The third Party can be a trusted friend or relative. However, the third-party is NOT responsible for nor obligated to pay your bill.

Third Party Information 



Please enter a valid value in the format of 999-999-9999.