Source for Business - KA Leak Allowance Application

Customer/company name*:

Customer reference number (10 digits)*:

Premises name:

Premises number & street name*:

Town/City*:

Postcode*:

Contact telephone number*:

Email*:

Meter details (if available) e.g. meter serial number:

What alerted you to the possibility of a leak? (high bill visible leak etc)*:

When were you alerted?*:

Today

e.g. date of high bill

How was the leak confirmed?*:

When was the leak confirmed?*:

Today

Where was the leak?*:

E.g. supply pipe, meter (please provide as much detail as possible)

Supporting pictures or drawings showing location of leak:

When was the leak repaired*:

Today

Details of the repair including evidence (include attachments below)*:

Please included what steps you took to actively repair the leak

Attachments:

Meter read taken after the repair*:

Only the black digits on the meter

Date of meter read*:

Today

Any additional information that may help your claim:

Security code:

Retype the numbers below:


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Leak Allowance Application