Difficulty paying your bill?

Income details

Are you receiving any income-related benefits? *

Yes

No

Please tick all the benefits you receive

Income Support

Universal Credit

Employment and Support Allowance

Pension Credit

Other (Please give details below)

Please provide details of the person receiving above benefits

Name of person who receives benefits*

Enter National Insurance number*

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Difficulty paying your bill?

Financial income statement

So that we can assess the most appropriate support for you, please complete the financial income statement below. Please select either Weekly or Monthly for each relevant income type based on the frequency in which you receive the income. You will then be asked to input the amount you receive.

Wages/salary

Housing benefit

Council tax reduction/support

Jobseekers allowance

Universal credit

Income support

Child benefit

Child tax credit

Working tax credit

Incapacity benefit/Employment & support

PIP/Disability living allowance

Other weekly income

Please provide any additional information in support of your application

Choose file

Remove file

Add another file

Please upload a maximum of 3 files with a total size of 7 MB.
Accepted file types are - .tif, .tiff, .doc, .docx, .xls, .xlsx, .jpg, .txt, .png, .pdf, .html, .htm, .mhtml

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Difficulty paying your bill?

Payment plan

If you currently have a payment plan on your account, your payments will be reviewed as part of this application. If you don't currently have a payment plan and would like us to set one up for you, please select your preferred option from the below:

Direct Debit - Please select this option below if you would like to pay by Direct Debit and spread your payments over the year. The great thing about paying by Direct Debit is that we give you a £5 annual discount for paying this way. You have control over the payment date and frequency that suits your life.

Payment card - If you would like us to send you a payment card so that you can pay your bill for free at a Payzone outlet or Post Office please select this option below.

Direct from your benefits - If you receive one of the following benefits and are already behind with your water bill payments, we can arrange for the Department for Work and Pensions to pay your water bill direct from your benefits. The benefits are Income Support, Income-based Jobseeker's Allowance, Pension Credit, Universal Credit and Income related Employment and Support Allowance. If your application is successful, you'll pay your current year's charges and a fixed amount towards your arrears.

Payment Plan

Please provide your bank account details and Sort Code and click the 'Verify bank details' button

Enter your bank account holder name*

Enter your bank account number*

Enter your bank sort code*

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Declaration*

The information I have provided is correct to the best of my knowledge and I have submitted accurate household income information. I understand that if I provide any information which is false, United Utilities may refuse my application. If my circumstances change and it may affect my application, I will inform United Utilities straight away.

I give permission to the authority that provides my benefit or tax credit to give United Utilities any further information to support my application and for my income to be verified with one or more Credit Reference Agencies.

Please tick this box to confirm acceptance of this declaration

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