Trusted Partner - Combined Support

Trusted Partner - Combined Support Application

Fields marked with * are required

Select Trusted Partner*

Referral agents initials*

Customers name*

Postal Address*

Customers contact phone number*

Customers email address

Customers date of birth*

Support Tariff Application

How many occupiers live in the household?*

Adults (19+)*

Children (0 - 18)*

Is any occupier in receipt of a means tested benefit?*

Total household income*

To include all benefits excluding disability or housing benefit

If the annual household income is under £18,725 does the customer confirm this?*

Please note: if the customer has an income over £18,725 but below £22,020 per year and their waste water provider is Southern Water, they will be eligible for a discount on their waste water only charges. Please complete the form and South East Water will apply the correct tariff. Water suppliers can be checked by postcode on the Water UK website at https://www.water.org.uk/customers/find-your-supplier

Does any occupier have any medical conditions that require extra water use?*

e.g. Incontinence, Chron's Disease.

Priority Services Application

Temporary reasons

Please tick all that apply

Families with young children (below 5 years of age)

Temporary life changes - i.e. recent bereavement, separation

Temporary - post hospital recovery i.e. restricted mobility for a period

Young adult house (bill payer is under 18 years of age)

If visually impaired, would the customer like to receive their bills in any of the following formats?

Please tick all that apply

Large Print

Braille

Audio

In the event of a loss of supply is someone within the property, or someone supporting them, able to collect water if necessary?*

Yes

Customer Declaration

Where any data collected relates to affordability the customer is aware that the information provided will be used to review eligibility and manage their tariffs.

The customer is aware that data will be held by South East Water in order to provide priority services

The customer is aware that the data will be provided to South East Water and that SEW will contact the customer by letter, phone or e-mail to confirm that they have received this information.

The data has been passed to South East Water in accordance with the agreed data share agreement.

The customer wishes to opt in to sharing with our trusted partners in the event of a loss of supply

For more information as to how we protect and use your personal data please see our Privacy Policy(opens in a new tab).

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Trusted Partner - Combined Support