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Customer Panel - Consent Form

Thank you for agreeing to participate in this market research project that we are conducting.

The aim of this research is to understand our customers views about the experience they expect from us as a business.

The results of the research will be used to help us develop and put in place improvements to our customer experience based around (our principles, and) the needs of our customers.

Fields marked with * are mandatory.

Contact Details

First name *
Surname *
Customer number (e.g. 1234567-8) *This can be found at the top right-hand corner of your bill (e.g. 1234567-8).
House/Flat name or number *
Street name *
Town name *
Postcode *
Contact number *
Email address *
Date of birth (DD/MM/YYYY) *Please enter your date of birth in this format - DD/MM/YYYY

Information about the collection & use of audio/visual recordings

The digital and social research session will be recorded and audio and visual outputs will be produced. These recordings will be listened to and viewed by Affinity Water when analysing the findings of the digital/ social research project. They will also be used for research purposes only to illustrate the research findings in the project reports and presentations submitted to Affinity Water colleagues. This may include attributed verbatim comments made by you during the research project. The recordings will not be used for any other purposes.

Privacy Information

The recordings contain your personal data and will be kept securely. The recordings will be automatically deleted once the digital development is completed or no later than 12 months after the recording was taken. For full details about our Privacy Policy can be found online at:

You have the right to withdraw your consent and/or have the specified data deleted at any time. If you have any queries about data protection, or your rights regarding data protection, please contact us and quote the Project name, Customer Focus Group You can contact us by phone, email or post, the details are:

Address: FAO Data Protection Officer, Legal Services, Affinity Way Ltd, Tamblin Way, Hatfield, Hertfordshire AL10 9EZ


Audio and/or visual recordings consent declaration

Consent: By signing this disclaimer you must read and confirm each of the following statements. If you agree to the use of the personal data as stated put a tick in the relevant box. If you disagree with the use of your personal data as stated please leave the box blank.


I agree to the audio and visual recording of me for the Customer Focus Group
I agree to the listening to and viewing recordings from Customer Focus Group by Affinity Water when analysing the findings of the Digital/social research project.
I agree to the use of my personal data such as attributed verbatims gathered in the audio and visual recordings to illustrate the research findings in the project reports and presentations submitted to Affinity Water.
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