Water and Sewerage Life Support Rebate Application Form

Water/sewerage accounts only

I hereby register as a customer dependant upon life support equipment.

This form is used for obtaining a rebate when you depend on life support equipment, which requires a fresh supply of water.

To complete this form you will need:

  • a printer (connected to your computer—this form needs to be printed and submitted to us)
  • a current letter of authority signed by your medical practitioner or an authorised officer of the ACT Department of Health, specifying the type of equipment and the amount of time in use.

Please note on approval of your application the rebate will be applied to your next bill.

Please print this form, complete your details, sign and attach the appropriate authorisation:

mail to:
Customer Services
GPO Box 366
Canberra ACT 2601

6248 3244

scan and email to:

Call 6248 3111 (opt 2) for assistance.

* Required fields

Applicant details




Account details


Equipment used

I, or a member of my household, is dependent on equipment requiring water supply.





Icon Water cannot guarantee that water supplies will never be interrupted. Every endeavour is made to notify you in advance, but unplanned interruptions to supplies may also occur without warning.

If uninterrupted water supplies are essential, it is your responsibility, as the applicant, to make alternative arrangements for emergency situations.