Excess Water Charges

~ 10min. to complete the form

Applicant Details

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Property/Remission Details

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I understand that if a remission is granted, it will disqualify me from being able to apply for a remission under this policy in the future.

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Declaration

I solemnly and sincerely declare that I have read and understood this application and certify that the information provided is true and correct in all respects, and that I am no less than 18 years of age. I have disclosed any other names that I am currently known under. I am aware that if I have deliberately provided false information in this application, I could face fraud or dishonesty charges in the Courts. I make this solemn declaration conscientiously believing the same to be true and correct by virtue of the Oaths and Declarations Act 1957.

Privacy Act Waiver

By submitting this application: Pursuant to the Privacy Act 1993, I authorise the Kaipara District Council to contact any agencies/companies or any other source including Government agencies to obtain and check (both now and in future) such information for the purposes of considering this application, and to assist in the enforcement of any agreement between myself and Kaipara District Council. I understand I have the right to access and information Kaipara District Council may have collected with regards to this application, and to correct it if it is wrong.


By submitting my application, I accept the terms & conditions and that the information I have provided is correct.