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Self declaration form - Watersure

Letting us know you’re still eligible for the scheme, you’re saying 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.


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When a customer applies for Watersure we promote our Priority Services Register. If you are already enrolled onto our priority service register, please confirm if you still require the service - if so, please sign below to confirm you are still eligible.If you aren’t already registered and you would like to enrol we need your consent that you are happy for us to hold and use your data to provide you with additional support. This means if you have a child in the property 2 years old or under or someone with a medical condition with the need to use more water, if there is a supply issue we can identify and give you extra support. Registered customers will receive prior notification of planned work, priority notification in case of any emergency and an alternative water supply where needed.

If you would like to enrol onto the Priority Services Register please complete the below.

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

Internal form number: WS001