Application for Assistance Leakage Policy Form

							                                                      Water and Wastewater Form (WW-1)
                                                                                                 Water and Wastewater

                Application Form
 Assistance under Council’s Water and Wastewater
                 Leakage Policy
Before completing this form, please read the Important Information regarding your water
leakage application on the reverse of this form.
                                                                       FOR OFFICE USE ONLY

RATE ACCOUNT NO: ____________________                                  PROPERTY NO:                  PN____________ /36


Name(s) of owner(s) in full:

Address of Owner(s):




Contact Tel. No:                                                           Mobile No:



Address of Property where leakage occurred:




Real Property Description:

Date property purchased:               /         /



Are you (the owner(s)) in receipt of a pension?                     YES / NO

If YES, type of pension:                                        Pension Card Number:



Please provide particulars relating to detection of leakage and plumbing repair:

Leak Detected:             /    /
Leak Repaired:             /    /            (please attach copy of plumber’s repair receipt)
Location of Leak/Comments:




I/We,                                                               ,believe that the information herein is correct.

Signature of Owner(s):                                                                       Date:         /     /

And/ or agent:                                                                               Date:        /      /

Please Note: all applications must be accompanied by a copy of the plumbing repair
document or, (if none available), a completed Statutory Declaration Form stating the
repair date and the location of the leak. e.g. in water pipe under driveway.


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                                              Water and Wastewater Form (WW-1)
                                                                             Water and Wastewater



                                 Important information
               regarding your Water and Wastewater Rate Relief Application


       Water leakage relief applies to a water leak that has occurred in the main supply pipe
        from the meter to the building. Therefore, tap leaks, pool leaks, hot water system
        leaks, leaks in showers, bathrooms, toilets, any walls in the building, or any area on
        the property other than the main supply pipe, does not qualify.

       Applications MUST be accompanied with a plumbing repair receipt/document.
        This receipt/document must state (minimum requirements):

                         1. Date of repair
                         2. Location of the water leak

       If a plumbing receipt/document is not available a Statutory Declaration must be
        provided stating the same above details.

       Receipts/documents relating to the cost of locating the leak (leak detection) will not be
        accepted.

       Water rate relief, if granted will be a 60% reduction of the water lost through the leak.
        The remaining 40% of the water lost through the leak, along with normal consumption
        will remain the responsibility of the property owner (note for eligible pensioners that
        leakage relief will be 85% reduction)

       Applications are processed in date received order and during busy rating times may
        take up to 8 weeks.

       Water leakage relief will only be granted once in a 3 year period.



    Send completed form to:
    The Chief Executive Officer
    Gold Coast City Council
    P O Box 5042
    GOLD COAST MAIL CENTRE QLD 9729

    or Fax to:
    (07) 5596 3653




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