Self declaration form WaterSure

The asterisk (*) symbol denotes required fields.

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







We want to make things as easy as possible for you. Usually, we need you to reconfirm you're still eligible for the scheme every year. However, if you have a lifelong medical condition then we'll only ask you confirm you're still in receipt of a qualifying benefit, and only every 5 years instead of 1.

If you've ticked Yes, we'll need you to provide evidence, to prove that you have a lifelong medical condition. This evidence can be a letter from your doctor or consultant to say that your condition will likely affect you for the rest of your life.

Once we have this, we won't ask you to give us this again. We'll just check in with you every 5 years to confirm that you're still in receipt of a qualifying benefit.

Attach documents

Please upload a file




If you are not currently paying on a payment plan, we will automatically set a monthly Watercard payment plan for you to help spread the cost of our water bill.

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

Internal form number: WS001