Helping Hand Scheme application form

Please use this form to apply for any or all of the special services that we provide for customers. This form can be submitted by a person who is not the account holder. However, in order for us to apply this information to an account, a Customer Account Number (as shown on the bill) must be provided.

 

*Required fields.

Your Details


 

Contact Details

Please provide details so that we can contact you if necessary.
  Mandatory if notification service required


 

Services requested

I would like to register for the following services.
(Please tick the appropriate box or boxes)


 

I have a medical condition which requires special consideration.


 


 


 

Nominee details
Please note that we will not be able to provide a nominee service unless full contact details are provided.



Download our leaflet

The leaflet "Our Helping Hand Scheme" is available to download in PDF format right here.

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