Check Eligibility What is your relationship to the property which you are applying for? Home Owner Private Tenant Landlord Council Tenant Please select all benefits which are being received within the household. Working Tax Credit Pension Guarantee Credit Housing Benefit (new eligible benefit under ECO4) Income Support Income related Employment & Support Allowance Income-Based Job Seekers Allowance Child Benefits Child Tax Credits Universal Credit Pension Credit Savings Credit (new eligible benefit under ECO4) Full or Part Time Employment (Household Income less than 31K) What type of property are you applying for? House Static Park Home Bungalow Flat/Maisonette How many bedrooms does the property have? 1 2 3 4 5 6+ What is the approximate age of the property? Pre 1900 - 1930 1930 - 1980 1980 - 2000+ Does your property have a suspended floor (floorboards), a basement or a cellar? Yes No Don't Know What is the main fuel which heats the property? Mains Gas Oil LPG Electric Storage Heaters Electric Panel Heaters Gas Central Heating Solid Fuel No Heating at all What type of solid fuel heats your home? Coal Burner Wood Burner Other Does your home have mains gas running to it? Yes No Full Name Address Street.. City Postal Code Phone Email Of Interest Free Electric Storage Heating Upgrade First Time Central Heating (FTCH) Free External Wall Insulation (EPC rating E,F & G only) Free Loft Insulation Free Internal Wall Insulation Free Cavity Wall Insulation Room in Roof (Attic Room) Insulation Flat Roof Insulation Underfloor Insulation Gas Boiler Replacement Grant (Non Condensing / Back boilers only) Solar PV None of these Submit
