Swedesboro, MT · Gloucester County
Winter Termination Program Self-Certification
This self-certification lets eligible Swedesboro-area utility customers request Winter Termination Program protection by documenting assistance or hardship and submitting the form to their utility company.
What this form is
The Winter Termination Program Self-Certification lets a customer request protection from utility service termination by identifying qualifying assistance or circumstances beyond their control. The form asks for the head of household’s name and address, the applicable assistance program or hardship, and a signature and date. Submitting it is optional; customers may instead tell their utility company verbally, and should contact the company to learn how it accepts the form.
Who needs it
Customers seeking Winter Termination Program protection may use this form if they receive a listed assistance benefit or cannot pay a utility bill due to circumstances beyond their control.
How to submit it
Submit the completed form to your utility company; contact its customer service number to learn how it wishes to receive the form.
About notarization
This form is signed and dated without a notary; it lists no notarized attachment or sworn step.
How to submit this form
- 1
Download The Form
Download the Winter Termination Program Self-Certification PDF.
- 2
Complete The Form
Enter the head of household’s name and address, select the applicable assistance program or hardship, and sign and date the form.
- 3
Submit To Your Utility
Send the form to your utility company using its preferred method; contact its customer service number to ask how it accepts the form.
Frequently asked questions
- Do I need a notary for the Winter Termination Program Self-Certification?
- No. The form calls for the customer’s signature and date, but does not require a notary or identify a notarized attachment.
- How do I submit the Winter Termination Program Self-Certification?
- Submit the completed form to your utility company. Contact its customer service number to learn how the company wishes to receive it.
- Is submitting this self-certification required for program protection?
- No. The form says submission is not required; customers may verbally advise their utility company of their eligibility instead.
- What information does the self-certification ask for?
- It asks for the head of household’s name and address, qualifying assistance or hardship circumstances, and the customer’s signature and date.
Need something notarized?
This Winter Termination Program Self-Certification doesn’t need a notary — but if you have another Swedesboro form that does, a commissioned online notary can help.