You may be eligible to receive support from our WaterSure Wales tariff if:

• You have a water meter (or agree to having a water meter installed)
AND

• You receive a qualifying benefit/tax credit:
  

  Income Support
  Income related Employment & Support Allowance
  Income-based Jobseeker's Allowance (JSA)
  Pension Credit
  Housing Benefit
  Attendance Allowance (AA)
  Working Tax Credit
  Child Tax Credit (except families in receipt of the family element only)
  Universal Credit
  Disability Living Allowance (DLA)
  Personal Independence Payment (PIP)

AND

• You or a member of your household has a medical condition that requires use of extra water:
  

  Desquamation (flaky skin disease)
  Weeping Skin (eczema, psoriasis, varicose ulceration)
  Incontinence
  Abdominal Stoma
  Crohn's Disease
  Ulcerative Colitis
  Renal failure requiring home dialysis
  If your condition is not listed here, but still requires a significant amount of water, you may provide information in your application.

OR

• You have 3 or more children under the age of 19, living at your home who you claim Child Benefit for.

This form is also available in Welsh.