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Leak Adjustment Request

Complete details of the leak adjustment policy are contained in City of Kitchener policy FIN-GRA-2014

Customer Name

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Service Address

Account Number

Phone Number

Email Address

Issue date of invoice with high consumption

Brief description of leak issue and how it was repaired:

Date leak repaired

Have you received a previous leak adjustment for this property?

Yes

Please attach Proof of Repair. Receipts for parts must be included with the application in order for it to be processed.

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To be eligible under the leak adjustment policy, the following conditions must be met:

That this is a residential property and that the water meter services one residential unit/property;
That this residential property was not vacant during the affected period;
That the residential property where the leak occurred was not unattended for more than five days; and,
The increased water consumption was not due to filling or leakage from a pool/hot tub, theft, vandalism or construction damage.

Acknowledgement

By checking this box and submitting this request, I confirm that the above conditions have been met and all of the statements in the leak adjustment form are true and accurate.

The personal information on this form is collected under the authority of the City of Kitchener Water Leak Adjustment Policy and will be used to administer the Water Leak Adjustment program. Personal Information may also be used by various divisions of the City of Kitchener under Sections 31 and 32 of the Municipal Freedom of Information and Protection of Privacy Act (MFIPPA). Where personal information provided on this application is inconsistent with existing City records, it may be used to update our internal records. Please note that your personal information will be stored in a Third Party server located in Waterloo, Ontario.

For questions regarding the collection, use or disclosure of this information should be directed to Revenue Division at 519-741-2450, or revenuecustomerservice@kitchener.ca