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How to complete this form

  1. Please complete all mandatory fields and upload any supporting evidence.
  2. We'll try to give you a decision within 10 working days, and we may contact you if we need any more information.
  3. 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:

Fields marked with * are mandatory.

Who is named on the bill?


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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