Application for Vulnerable Group Tariff

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Dee Valley Water plc

Registered Office:
Packsaddle
Wrexham Road
Rhostyllen
Wrexham LL14 4EH

Registered in England & Wales No. 3527628

	Application for Vulnerable Group Tariff
	Personal Details
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	Telephone	E-mail

	Address Information
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	Billing Details
	Billing Reference Click to show how to find billing reference
	Supportive Information
	Are you in receipt of any of the benefits or tax credits listed below:
	Council tax benefit
	Housing benefit
	Income support
	Child benefit
	Income based job-seeker's allowance
	Child tax credit (except families in receipt of the element only)
	Pension Credit
	Are you diagnosed as suffering from, and receiving treatment for any of the medical conditions listed below which as a result would require you to use a significant volume of water:
	Desquamation Weeping skin disease Incontinence Abdominal stoma Renal failure requiring home dialysis Crohn's disease Ulcerative Colitis