Water Charge Refund Application

Your Details

Title

First Name

Last Name

Home Telephone Number

Mobile Telephone Number

Email Address

Current DBC Tenancy Number (if applicable and if known)

If you would like refunds transferred to your current tenancy rent account - please tick

Your Current Address

Postcode

Your Claim – Former Tenancy details

It is important that you add any former details below to assist us with your claim

If you are having trouble remembering the postcode, please check on the Royal Mail Postcode Finder

Former Title (if applicable)

Former Surname (if applicable)

Former DBC Tenancy Number (if known)

Postcode

Your Bank Details

Please provide the following details of the bank account you wish the payment to go into:

Name on the Bank Account

Bank Sort Code (XX-XX-XX)

Bank Account Number (UK ONLY)

Name of the bank you hold the account with

Additional information to support your application.

Please upload a copy of a bank statement for the account referenced above.

Declaration

I confirm that the information that I have provided above is true and accurate.
All refunds are transferred electronically into your nominated bank account (using the BACS system).
We do not make refunds in cash or by cheque.

Please Note: Your account balances will be checked before we make any refund. If you have any other outstanding debt for a Dacorum Borough Council Service then all or part of your credit may be used to clear the amount you owe.
All details on this form will be held securely and will not be shared.

Do you agree to the above declaration?

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Your Details

Your Current Address

Your Claim – Former Tenancy details

Your Bank Details

Declaration