Self declaration form - Watersure

This form lets you tell us that you’re still eligible for the Watersure scheme. You’re telling us that your circumstances haven’t changed, and you’ll continue to benefit from capped water bills.

  • If you let us know you're no longer eligible for the scheme, future bills will be based on the amount of water you use. 
  • If we don’t receive the ‘self declaration form’ back, we’ll assume you are no longer eligible & remove you from the scheme, a new application will have to be submitted to get back onto the scheme.

The asterisk (*) symbol denotes required fields.

About you

 

 

Benefit

 

 

Medical

 

 

Family

If you are not currently paying on a payment plan, we will automatically set a monthly Watercard payment plan for you to help spread the cost of our water bill.

Please check you have completed all the sections that are true and reflect your circumstances before you submit the form.

Internal form number: WS001