Self declaration form - Watersure | Get in touch

Are you in receipt of any of the following benefits? If yes please tick all that apply

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If you answered no to the above: Are you in receipt of DLA or PIP? If yes, please tick the box that applies

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As your WaterSure application includes information about your medical condition, we need your consent to process your application. I consent to my medical information being processed

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Do you have a medical condition which requires the use of additional water? *

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Please tick the box if: *

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