Apply for the low income fixed tariff

How to complete this form

Complete the form below, please complete all mandatory fields and upload any supporting evidence.
We will try to give you a decision within 10 working days, and we may contact you if we need any more information.
If your application is not successful we will tell you why.

Do you need help completing this form?

Call us on 0345 357 2401 (lines open Mon - Fri 8am - 8pm, Sat 8am - 2pm) or email: mybill@affinitywater.co.uk

Fields marked with * are mandatory.

Who is the person named on the bill?
Title *
First name *
Last name *
Address *
Postcode *
Daytime telephone number
Evening or mobile telephone number
Email address
Customer number (e.g. 1234567-8) *
You can find this on the top right hand side of the water bill.

Council tax & support
Do you receive any council tax reduction or support? *
If yes, please attach proof of this benefit.

Declaration
The information I have given is correct to the best of my knowledge and I understand that if I provide any information which is false, you may refuse to consider my claim. If my circumstances change and it may affect my claim, I will tell you straight away. I give permission for the Authority who gives me benefit or tax credit to give you any information to confirm the information I have provided. Warning - If you deliberately give us misleading information you are committing a criminal offence and could be prosecuted.

Agreement
My household meets the conditions for help under the Low Income Tariff *
I have read the above statement and confirm that the information I have provided is true *

Supporting documents
Please upload a copy of your latest notice of entitlement or bank statements if you qualify on the basis of income. This must be in the same name as the water account holder and should also show their address. Without the supporting documents your application can not be processed.
Upload document *
Additional document upload (if required)
Additional document upload (if required)
To upload a document, click the 'Choose file' button then find the document on your computer and double click or choose 'Open'.
Any additional information

How did you hear about the Low Income Tariff?
If other, please give details

Data protection: The information you provide may be used by Affinity Water to provide you with water services, give you information about your water supply and manage your account; including the collection and recovery of charges. We also collect charges on behalf of Thames Water and Anglian Water who provide sewerage services in our supply area. Read our full privacy policy.

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Apply for reduced bills with the low income fixed tariff

How to complete this form

Do you need help completing this form?

Who is the person named on the bill?

Council tax & support

Declaration

Agreement

Supporting documents