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Customer Panel - Consent Form

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

For the second part of your participation. We have engaged with Acumen Fieldwork who will contact you on behalf of Affinity Water to confirm your attendance to an online customer panel to talk about bespoke topics e.g., MyAccount, Home Move.

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

How we will collect and use your information

Data Held by Acumen Field

If you consent to participation in this second part of the focus group, your name and contact information will be shared with Acumen Field who will contact you to confirm your attendance and only used for the purposes of this project.

Data Held by One4all

Data Held by One4all Once you took part in the focus group, your name and email address will be shared with One4all so that they can send you your £20 e-voucher gift as a thank you. This will only be used for this purpose.

Data Held by Affinity Water

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 my name and contact details being shared with Acumen Field for the purposes outlined above
I agree to my email address being shared with One4all for the purposes outlined above.
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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