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Financial Statement

Completing a Financial Statement with a National Grid agent involves answering some questions pertaining to your household composition (number of adults and children), assets (bank accounts, investments), as well as monthly income (salary, public assistance, social security, etc) and expenses.

If applying for a Minimum Payment Agreement only a Financial statement is required, which can be completed with an agent over the phone or by using the Financial Statement Calculator. No proof is required to be submitted, but National Grid reserves the right to request proof documents if necessary.

If requesting a Medical Emergency Renewal, proof documents will be required along with a completed Financial Statement.

Please review the list of financial items below, and have the actual documents or figures available before calling National Grid. If you have any questions, or would like to complete a Financial Statement with an agent, please call 1-800-443-1837. You may also complete the financial statement yourself online, and if necessary, submit proof, with our Financial Statement Calculator.

Send in all that apply:

  • Pay Stub: 4 consecutive weeks
  • Letter from Employer: Printed on company letterhead, signed and dated.
  • Income Tax Return
  • Business Records
  • Notarized Letter from employer: Must show amount.
  • Self Employed: Signed and dated income tax return and all schedules records of earnings and expenses.
  • Unemployment Benefits: Award Letter/Benefit Check/Correspondence from NYS
  • Private Pension/Annuities: Statement from pension/annuity.
  • Social Security: Award Letter/Benefit Check/Correspondence from Social Security Administration.
  • Child Support/Alimony: Notarized letter from person providing support, or letter from court, child support/alimony check stub.
  • Workers Compensation: Award Letter/Check stub.
  • Veterans Benefit: Award Letter/Benefit check stub/correspondence from Veterans Administration.
  • Military Benefit: Award Letter/Check Stub
  • Interest/Dividends/Royalties: Statement from financial institution, notarized letter from broker, notarized letter from agent.
  • Income from Rent/Room and Board: Notarized letter from roomer/boarder/tenant, rent receipt with date and amount and address, signed valid lease agreement.
  • Income from Section 8
  • Support from Others: Notarized signed statement from person providing support.

Send in all that apply:

  • DSS Denial Letter
  • Notarized letter from source of rent/housing funding
  • Notarized letter from family member who is paying living expenses
  • SNAP Denial Letter/Approval Letter
  • File Federal Form 4506-T

Shelter - Mortgage, signed valid lease agreement, notarized landlord statement, rent receipt including current date, amount and address, SNAP budget sheet, notarized DSS form, HUD/Sec 8

Real Estate Tax - Property and school taxes unless included in mortgage.

Home Owners / Rental Insurance - Receipt for rental insurance. If the home insurance is included in the mortgage, do not include.

Utilities - Average Utility Bill

Other Fuel - Provide bill if any other than National Grid.

Car Payment - Monthly car payment.

Car Insurance - Copy of statement.

Medical Expenses - Monthly amount of out-of-pocket expenses for health care, prescriptions which are current and/or are on an installment payment plan (Do not include the total figure of past due debts). Also, include average amount on a monthly basis for health insurance.

Basic Phone - Phone bill.

Child Care Expenses - Any essential employment-related childcare expenses for the month.

Court Ordered - Monthly expenses such as child support, alimony, or garnished wages.

Other Expenses - Water/sewer and trash removal (if not included in the rent), Laundromat services, installment or rental payments on major household appliances such as a stove, refrigerator, washer/dryer. EAF/EAA payback installments, second mortgage or home equity payments if against the primary residence.

How to Submit

To expedite, you may submit your Financial Statement and, if necessary, documents online using our Financial Statement Calculator.

If submitting for Medical Emergency Renewal: You may also fax or email documents to the fax number and email address provided below. Please include your name, phone number and bill account number on all correspondence. National Grid accepts photos of proof taken from your cell phone and submitted attached to the Financial Statement Calculator. Please make sure the entire document is visible in the photo (both sides if necessary), and to select Medium Size resolution before sending. Also be sure to redact (black out) all personally identifiable information (PII) such as Social Security numbers and Bank Account numbers. Please remember that although you may send us your documents via email or fax, we will still need a completed Financial Statement either done using the Online Financial Statement Calculator or by calling Customer Service at 1-800-642-4272.

To submit a financial statement and proof documents for a Medical Emergency Renewal:

  • Submit Financial Statement and provide documents online: Fill out the Online Financial Statement Calculator. Select “I am renewing my Medical Emergency Protection” for the reason you are completing the Financial Statement.
  • Send in documents via email or fax, after completing a Financial Statement Online or with Customer Service: