Claim for Loss of Gross Profit

Please read the guidance before completing this form

The purpose of this section is to allow us to identify you as a Welsh Water customer and assess whether you have experienced disruption during the period eligible for consideration of goodwill payments.

Please note that information you supply may be shared with our appointed third-party representatives to assess your application or used to update our records.

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Your Welsh Water business account

We need the following information to retrieve your Welsh Water customer account.

Your Welsh Water Customer Reference Number

Business name (“the Applicant”)

Contact person (for Business)

Title in business

Confirm Email

Contact number

Contact will predominantly be via email. We or our third-party partners may call you to discuss any complex or urgent queries regarding your application

Principal business activity (such as shop, restaurant)

Is the business VAT registered? Yes No

When was the business interrupted?

Start date (dd/mm/yyyy)

Start time (12hr or 24hr format)

End date (dd/mm/yyyy)

End time (12hr or 24hr format)

Please describe how the business was impacted by the loss of supply, including impact on customers:

Please outline any steps taken to enable the business to keep operating:

Has the business made a claim on an insurance policy relating to the loss of supply? Yes No

How can we help you?

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Claim for Loss of Gross Profit

Your Welsh Water business account

When was the business interrupted?