Low income tariff application form

Our LIFT fixed-tariff is aimed at customers who have a low household income or are claiming benefits.

If you answer YES to either of the statements below then you are eligible for LIFT.

  • My household income is less than £16,105 excluding benefits. I am the person named on the water account and can supply evidence of my income that shows my name and address.

  • I am claiming one of the following benefits - Income related Employment and Support Allowance, Income Support, Job Seeker’s Allowance, Housing Benefit, Universal Credit, Pension Credit. I am the person named on the water account and can provide supporting evidence of my benefits that shows my name and address.

Please note:

If you qualify based on the criteria above, your water charges will be fixed at £97.50 per year from 1st April 2018 (not applicable for the sewerage element of your bill). If your current water charge is less than £97.50 you may not qualify.

 


How to complete this form

  1. Complete the online form below (Please complete all mandatory fields and upload any supporting evidence)

  2. We will try to give you a decision within 10 working days. We will contact you if we need 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 Metered or 0345 357 2402 Non Metered (open Mon - Fri 8am - 6pm, Sat 8am - 2pm)

email: advancecareteam@affinitywater.co.uk

Please contact us if you would like this form in large print or different formats (braille or audio)

Fields marked with * are mandatory.

  • 1Your Details

Who is the person named on the water bill?

Title *
First name *
Last name *
Address *
Post code *
Daytime phone number
Evening or mobile number
Email address
Customer number *

National Insurance details

Please give the name and National Insurance number of the person who receives one or more of the benefits or tax credits.

Full name *
National Insurance number *Please enter your NI number so we can process your application

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 the latest 'notice of entitlement' for benefit. 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.

Please note: You may add a second document but the total files uploaded should not be larger than 3mb. 

Upload document *
To upload a document, click on 'Browse' then find the document on your computer and double click or choose 'Open'.
Additional document upload, if required.

How did you find out about the Low Income Tariff?

Please select
If you selected other please provide 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 here>> 

   

We have more services that could benefit you click here to find out more.