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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.

About you

Benefit

Medical

Family

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

Internal form number: WS001