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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 a Discount Rate you will also have to submit your Financial Hardship Form below.
Please enter a valid value in the format of 12345-67890
Please enter a valid value in the format of 12345-67890
Please enter a valid value in the format of 999-999-9999
Please enter a valid value in the format of 999-999-9999
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 with 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: .jpg, .jpeg, .png, .tif, .pdf
File extensions allowed: .jpg, .jpeg, .png, .tif, .pdf
File extensions allowed: .jpg, .jpeg, .png, .tif, .pdf
File extensions allowed: .jpg, .jpeg, .png, .tif, .pdf
File extensions allowed: .jpg, .jpeg, .png, .tif, .pdf
File extensions allowed: .jpg, .jpeg, .png, .tif, .pdf
File extensions allowed: .jpg, .jpeg, .png, .tif, .pdf
Medical Protections
Medical Protection - A household qualifies for Serious Illness Protection when the household is experiencing financial hardship and a document confirms a patient with a serious or chronic illness resides in that household. This document must be written by a registered physician, physician assistant, nurse practitioner, or local board of health. It must state the name and address of the seriously ill person and whether the illness is serious (90 day protection) or chronic (180 day protection).

File extensions allowed: .jpg, .jpeg, .png, .tif, .pdf
File extensions allowed: .jpg, .jpeg, .png, .tif, .pdf
Infant Protections
Infant Protection -  A household qualifies for Infant Protection when the household is experiencing financial hardship and a child under 12 months of age resides in that household. A valid birth certificate or a letter or official documents issued by a registered physician, physician assistant, nurse practitioner, local board of health, hospital or government official, Department of Transitional Assistance, clergyman, or religious institution is required to qualify. The document must list the name and birthdate of the infant.

File extensions allowed: .jpg, .jpeg, .png, .tif, .pdf
File extensions allowed: .jpg, .jpeg, .png, .tif, .pdf
File extensions allowed: .jpg, .jpeg, .png, .tif, .pdf
File extensions allowed: .jpg, .jpeg, .png, .tif, .pdf
File extensions allowed: .jpg, .jpeg, .png, .tif, .pdf
Financial Hardship Form
Please indicate below whether your National Grid Account is on a Discount Rate. If you are NOT on a Discount Rate you're required to fill out the Financial Hardship Form 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 the household and their date of birth (including children). For each person in the household, list their income source(s), income amount, and how often that amount is received. (Click Add Additional Person below to list additional people.)
Household Person Information
MM/DD/YYYY
Please enter the amount with a decimal point (i.e. 100.00)


Third Party Notification
The Third Party Notification program allows you to select a person to receive copies of certain communications by mail that you receive from us related to your account. They will receive notifications of past due bills and disconnect notices. 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.

This application is for customers based in Massachusetts. To learn more about Special Protections in your area, please visit the Long Island Special Protections website.

This application is for customers based in Massachusetts. To learn more about Special Protections in your area, please visit the New York City Special Protections website.

This application is for customers based in Massachusetts. To learn more about Special Protections in your area, please visit the Upstate New York Special Protections website.