Here2Help Scheme application form | Get in touch

Here2Help Scheme application

By completing this form you are applying for our Here2Help scheme where you could be eligible for up to 70% of the average household bill.

{panel-id} Evidence check list

The asterisk (*) symbol denotes required fields.

To see if you’re eligible we need details of your full household income and evidence to support this.

Below is a quick checklist of what you will need to complete the online application, please make sure you have all the information ready before starting.

Please provide 3 months of evidence to support your income shown on section 7 of this application – Income is classed as any money coming into the household from any occupants. Any salary amounts should be after tax and national insurance.

Evidence checklist

All documents must clearly show your name and address as well as the amounts you receive.
If you are sending a DWP or HMRC letter to confirm the benefits received, the letter must be less than 1 year old and clearly show the weekly/monthly payment
If you are sending proof of Universal Credit, you must provide all pages of the breakdown showing how your Universal Credit has been calculated.
If you are sending wage slips, they must be recent and consecutive. We also need you to send a minimum of 3 in total.
If you are sending a bank statement it must be dated within the last 3 months and show all household income and amounts received.

We do not need evidence for the elements of benefits listed in the grey section of the income sheet, e.g. Housing Benefit, Disability living allowance and Personal Independence payments.

We can accept screenshots and pictures as long as they meet the above criteria. For Universal Credit, this can be done from your online journal – Please ensure you send all pages for the full 3 months.

Ensure you have read and considered the above. You will not be able to complete this form without the correct supporting evidence *

Please select a title

{panel-id} Your details

The asterisk (*) symbol denotes required fields.

Account number: *

Please enter a valid account number:

First name: *

Please enter a valid first name:

Surname: *

Please enter a valid surname:

1st Line of address: *

Please enter a valid 1st line of address:

Postcode: *

Please enter a valid postcode:

Contact number: *

Please enter a valid contact number:

Email address *

Please enter a valid email address

Date of birth:

Please enter a valid date of birth:

Additional contact details

You only need to complete this If you would also like us to discuss your application with somebody else

Account number:

Please enter a valid account number:

First name:

Please enter a valid first name:

Surname:

Please enter a valid surname:

1st Line of address:

Please enter a valid 1st line of address:

Postcode:

Please enter a valid postcode:

Contact number:

Please enter a valid contact number:

Email address

Please enter a valid email address

Date of birth:

Please enter a valid date of birth:

Relationship to Account Holder:

Please enter a valid relationship to account holder:

Data Protection

Hafren Dyfrdwy will process your data as set out in our privacy notice.

The purpose of the data collection is to allow us to provide appropriate support using the available schemes to manage your account and debt under the lawful basis of legitimate interest.

Please contact dataprotection@severntrent.co.uk if you have any questions, concerns or complaints about this privacy notice.

We would like to contact you in the future to find out what you thought of the service you have received here. This helps us to improve our service for others.

I am happy for you to contact me to find out what I thought of the service: *

Please select a title

{panel-id} You and your household

The asterisk (*) symbol denotes required fields.

Total number of people in household (aged 18+): *

Please enter a valid total number of people in household (aged 18+):

Number of dependent children (13 and below): *

Please enter a valid number of dependent children (13 and below):

Number of dependent children (14-18): *

Please enter a valid number of dependent children (14-18):

{panel-id} Household income

The asterisk (*) symbol denotes required fields.

Please provide the total annual household income for all adults.

Take home pay *

Please enter a valid take home pay

Partners take home pay *

Please enter a valid partners take home pay

Income from lodgers or property *

Please enter a valid income from lodgers or property

Self-employment income *

Please enter a valid self-employment income

Private / Occupational Pension *

Please enter a valid private / occupational pension

State Pension *

Please enter a valid state pension

Child Maintenance *

Please enter a valid child maintenance

Interest from savings & investments *

Please enter a valid interest from savings & investments

Student Loan (not Grant) *

Please enter a valid student loan (not grant)

Other - Please specify *

Please enter a valid other - please specify

Working Tax Credit (excluding disability premiums) *

Please enter a valid working tax credit (excluding disability premiums)

Child Tax Credit (excluding disability premium) *

Please enter a valid child tax credit (excluding disability premium)

Pension Credit (excluding disability/carer premiums) *

Please enter a valid pension credit (excluding disability/carer premiums)

Income-based JSA (excluding disability/carer premiums) *

Please enter a valid income-based jsa (excluding disability/carer premiums)

Income Support (excluding disability/carer premiums) *

Please enter a valid income support (excluding disability/carer premiums)

Income related ESA (excluding Support Group, work related Activity Group & disability/carer premiums) *

Please enter a valid income related esa (excluding support group, work related activity group & disability/carer premiums)

Universal Credit (excluding Housing Carer, Disabled Child & limited capacity for Work Element) *

Please enter a valid universal credit (excluding housing carer, disabled child & limited capacity for work element)

Universal Credit deductions e.g. for take home pay (Excluding benefit caps or deductions for payments of services) *

Please enter a valid universal credit deductions e.g. for take home pay (excluding benefit caps or deductions for payments of services)

Incapacity Benefit *

Please enter a valid incapacity benefit

Child Benefit *

Please enter a valid child benefit

Maternity Pay / Allowance *

Please enter a valid maternity pay / allowance

Statutory Sick Pay *

Please enter a valid statutory sick pay

The following sections will be excluded and should NOT be counted as available income for Here2Help.

Housing Benefit or Housing Element of Universal Credit *

Please enter a valid housing benefit or housing element of universal credit

Council Tax Reduction / Support *

Please enter a valid council tax reduction / support

Support Group, Work related Activity Group & Disability/Carer premiums on ESA *

Please enter a valid support group, work related activity group & disability/carer premiums on esa

Disability premiums on Child / Working Tax Credits *

Please enter a valid disability premiums on child / working tax credits

Disability / Carer premium on Pension Credit, JSA & Income Support *

Please enter a valid disability / carer premium on pension credit, jsa & income support

Disabled Child & Limited Capability for working elements of Universal Credit *

Please enter a valid disabled child & limited capability for working elements of universal credit

Attendance Allowance *

Please enter a valid attendance allowance

Disability Living Allowance *

Please enter a valid disability living allowance

Personal Independent Payment *

Please enter a valid personal independent payment

Carers Allowance or Carers Element of UC *

Please enter a valid carers allowance or carers element of uc

Total Income *

Please enter a valid total income

Total deductions *

Please enter a valid total deductions

Total Exclusions *

Please enter a valid total exclusions

New total income (minus exclusions and deductions) *

Please enter a valid new total income (minus exclusions and deductions)

{panel-id} Any other information

The asterisk (*) symbol denotes required fields.

Please provide us with any other information that you feel will support your application?

Please enter your description

{panel-id} Payment options

The asterisk (*) symbol denotes required fields.

How would you like to pay your water bill? *

Please select a title

How often would you like to pay your water bill? *

Please select a title

Please note we only offer Direct Debit on a fortnighlty and monthly basis. If you would like to pay weekly please choose a Watercard as your payment option.

Which day of the month would you like to pay *

Please select a title

{panel-id} Confirmation

The asterisk (*) symbol denotes required fields.

Please provide 3 months of evidence to support your income

All documents must clearly show your name and address as well as the amounts you receive.
If you are sending a DWP or HMRC letter to confirm the benefits received, the letter must be less than 1 year old and clearly show the weekly/monthly payment
If you are sending proof of Universal Credit, you must provide all pages of the breakdown showing how your Universal Credit has been calculated.
If you are sending wage slips, they must be recent and consecutive. We also need you to send a minimum of 3 in total.
If you are sending a bank statement it must be dated within the last 3 months and show all household income and amounts received.

We do not need evidence for the elements of benefits listed in the grey section of the income sheet, e.g. Housing Benefit, Disability living allowance and Personal Independence payments.