Application for financial assistance - Concealed water leak

Note: Please refer to the Concealed Water Leak Policy (PDF) for details before completing this form.

Property owner details

Surname *

Given name *

Daytime phone *

Email: *

Property details where concealed leak has occurred

Property address (street number and street name) *

Suburb *

Assessment numberYour assessment number can be found on your Water Usage notice.

Do you receive Council Pensioner Remission for this property?

YesNo

Licensed plumber engaged to make repairs

Business name *

Plumber's name:

Plumbing Licence number:

Plumber's phone number *

Date of repairs

Please upload a copy of the Plumber's invoice *

Browse

For paper invoices, please scan or take a clear photo of the original document.

I have read and understood the extent of assistance available under the Concealed Water Leak Policy. *

Information privacy statement

We are collecting your information in order to process your application for financial assistance relating to a concealed water leak. Your personal information is used for the purpose of delivering services and carrying out Council business. It is handled in accordance with the Information Privacy Act 2009 and will be accessed by persons who have been authorised to do so. The information may be disclosed to your nominated licensed plumber but will not be given to any other person or agency unless you have given Council permission or the disclosure is required by law.