WaterSure Application - Children under 19 | Get in touch

Bill Cap scheme - WaterSure application

Complete this application form if you're applying for someone with children under 19

{panel-id} Tell us about the person named on the water bill

The asterisk (*) symbol denotes required fields.

Account number:

Please enter a valid account number:

Title: *

Please enter a valid title:

First name: *

Please enter a valid first name:

Last name: *

Please enter a valid last name:

Postcode *

Please enter a valid postcode

Telephone number: *

Please enter a valid telephone number:

Email address: *

Please enter a valid email address:

Confirm Severn Trent provide the water services at this property *

Please agree to our terms and conditions

{panel-id} Child benefit

The asterisk (*) symbol denotes required fields.

I can confirm that someone living at this address receives benefit for 3 or more children, under the age of 19, who live with us permanently

Please agree to our terms and conditions

Name of person receiving child benefit (if different from account holder)

Please enter a valid name of person receiving child benefit (if different from account holder)

Please tell us the name and date of birth of each child under 19

Please enter your description

You must provide a copy of the latest notice of entitlement to child benefit for each child you have named above.

Alternatively, you can supply a copy of the most recent bank statement listing your current entitlement and payments.

This also needs to show the name and address of the person claiming child benefit.

Priority Services

Following your application for WaterSure, we would like to offer you another free service, our Priority Services Register.

To enrol on the Priority Services Register 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 there is a supply issue, we can make sure you get the support you need.

Registered customers will receive prior notification of planned work, priority notification in case of any emergency and an alternative water supply where needed.

Yes, I would like to enrol on the Priority Service Register

Please agree to our terms and conditions

Attach documents *

Select File Please upload a file

Attach documents

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Attach documents

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{panel-id} Payment plan

The asterisk (*) symbol denotes required fields.

If you have a payment plan on your account, we’ll let you know in writing how this changes once you’re on WaterSure. It is important to note that if you do not select a payment option, we will automatically set up a monthly watercard plan on your account and details will be issued to you.

The way you pay (whether that’s direct debit or watercard) will stay the same. If you’ve got arrears on your account, your payment plan will include an amount towards the arrears.

If you don’t have a payment plan, or want to change the method of payment, please specify your preferred payment plan option below.

Direct Debit

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Watercard

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Paying for your water charges directly from your benefits

If you’re in receipt of any of the following benefits, and have arrears of more than £50 on your account, you may be eligible to have your water charges paid directly from your benefits.

Income support
Job seekers allowance
Employment Support Allowance
Pension Credit
Universal Credit - the amount of arrears needed to qualify may differ, dependant on your circumstances.

We just need your full name and National Insurance Number.

If you’re successful, you’ll pay your current charges and a fixed amount towards your arrears.

If you don’t choose a payment option, we’ll set up a monthly watercard payment plan for you.

Please confirm you would like to sign up pay your water charges directly from your benefits:

Please agree to our terms and conditions

Your full name:

Please enter a valid your full name:

National Insurance Number:

Please enter a valid national insurance number:

{panel-id} Declaration

The asterisk (*) symbol denotes required fields.

The information I’ve given is correct to the best of my knowledge and I understand that if I provide any information which is false, you may decline my application.

I will tell you if my circumstances change in any way that would affect my WaterSure eligibility e.g. change in benefits.

I give you my permission to contact third parties to confirm the information I’ve given is correct.

If I pay my sewerage charges to a different company, I give you permission to pass on the details I’ve provided so you can also consider my sewerage charges under the WaterSure scheme.

I give you permission to update my record to show me as a priority water customer which will give me assistance in the event of an interruption to my water supply.

I confirm the following:

A member of my household meets the conditions for help under the WaterSure scheme.
I only use a hosepipe or watering can to water my garden.
My household does not have an auto-filling swimming pool or pond which holds over 10,000 litres of water.
I do not receive any help towards the cost of water from the health authority.
I am not aware of any leaks at the property.
The property is not used for any commercial purposes.

I give my permission for the person in receipt of benefits to be added to the account, if not already named, in order to benefit from the WaterSure scheme.

I confirm I have read and agree with the above statement *

Please agree to our terms and conditions

Please tick the box if you consent to your details being held and used by Severn Trent Water Ltd. *

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Please tick the box if you DO NOT wish to hear about products and services we offer by post/telephone/email.

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