Water Support Form


Untitled Document

Application for Water Support Scheme



We will use all the personal data you provide with this application to verify your eligibility.

*mandatory fields


Customer Details
Mr
Miss
Mrs
Ms



(In case we need to discuss your application, please provide a telephone number to contact you on.)



Yes
No


In order to apply, please answer ALL questions below



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No
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*Declaration by the Applicant or Advice Worker


The Applicant consents to SES Water using the data provided to assess eligibility for financial assistance. The Applicant/Advice Worker confirms that the information provided is up to date and factually correct. You agree to provide, when asked for, any further information that may be required to confirm you are eligible for the tariff to support your application or renew it each year.


Please tell us how you found out about this scheme.






OR



Water Sure Plus

In order to apply for the waste water discount from Thames Water (WaterSure Plus Scheme) you must complete all sections below and the previous section.If you are only applying for SES Water's Water Support Scheme (for your fresh water) you do not need to complete any more information. If you are billed by Southern Water for waste water then please ignore this section. Any information provided on this form will be shared with Thames Water to provide eligibility for the scheme and provide financial assistant.


Financial Statement

Please ensure you include ALL NET MONTHLY Household Income for the entire household

Net monthly household income is the amount of money your household receives after tax/net of deduction per month.
If not applicable please enter "0"


  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
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  If you would like more information about the data we collect please visit our privacy policy.




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