Vulnerable Customers Registration Form

Uisce Éireann recognises that some of our customers have different needs when it comes to using our water services and communicating with us due to age, disability or medical conditions.

To look after our vulnerable customers, we have developed a priority and special services register. To register yourself or somebody in your home as a vulnerable customer, please complete the form below.

* are mandatory.

To register for priority or special services, please complete the relevant sections of the below form.

Full name of vulnerable customer

Uisce Éireann will send the vulnerable customer (or their alternative contact) a text message with details of any relevant supply interruption over four hours in duration. Please contact Uisce Éireann on 1800 278 278 if you would prefer to receive a phone call or do not have a mobile number

If you would like Uisce Éireann to contact you by phone for these services please tick this box.

First name *

Last name *

Mobile Phone number

Priority services register

Do you wish to register yourself or somebody in your home for priority services (for those critically dependent on water for a medical condition).

Yes

This register will allow us to identify customers in most need of priority services. To help us ensure we meet that commitment, we may seek proof of your medical condition.

Please tick here if you are currently a Home Haemodialysis Patient

Special services register

Do you wish to register yourself or somebody in your home for special services?

Yes

How would you describe the person registering for special services?

are aged 66 or over

are blind or vision impaired

are deaf or hard of hearing

have mobility difficulties

have an intellectual disability; or

have a mental health difficulty

Services for blind or vision impaired customers

Please indicate below if you would like to receive further correspondence:

In Braille

With Audio Assistance (for example a Talking Household Water Conservation bill)

Full name of named customer

If the vulnerable customer and the named customer are the same person, check this box.

First name *

Last name *

Please provide your supply address

Please contact Uisce Éireann on 1800 278 278 if you do not have your WPRN to hand.

Address line 1

Address line 2

Address line 3

WPRN

Eircode

Find your Eircode here

County *

Contact details

Mobile phone number *

Email address

Account details

Please contact Uisce Éireann on 1800 278 278 if you do not have your account number to hand.

Account number

Nominate an alternative contact

Would you like to nominate an alternative contact?

If you wish to nominate an alternative person (such as a family member or friend) to deal with your correspondence, or to be contacted about issues with your water supply, please fill in their details below:

First name *

Last name *

Please provide your supply address

Address line 1 *

Address line 2 *

Address line 3

Address line 4

Eircode

Find your Eircode here

County *

Contact details

Mobile phone number *

Email address

Consent

Uisce Éireann will process personal data provided in accordance with Uisce Éireann's Privacy Notice.

Uisce Éireann may share such information with authorised agents or third parties who act on behalf of Uisce Éireann to enable us to provide the services set out in the Domestic Vulnerable Customer Code of Practice (the 'Code').

By providing such information to Uisce Éireann and clicking 'Send' below, you, the named customer, consent to Uisce Éireann collecting, using, transferring and disclosing your personal data as described in the Privacy Notice and the Code.

Where the vulnerable customer or alternative contact is not the named customer, by providing their personal data and clicking 'Send' below, you, the named customer, confirm that the vulnerable customer has consented to you providing their personal data and to Uisce Éireann collecting, using, transferring and disclosing your personal data as described in the Privacy Notice and the Code.

Please verify that you are not a robot

Vulnerable Customers Registration Form

Services for blind or vision impaired customers

Account details

Nominate an alternative contact

Please provide your supply address

Contact details

Consent

Customer Care

Resources

Company

Switch Language

Vulnerable Customers Registration Form

Full name of vulnerable customer

Priority services register

Special services register information

Services for blind or vision impaired customers

Full name of named customer

Please provide your supply address

Contact details

Account details

Nominate an alternative contact

Please provide your supply address

Contact details

Consent

Special services register