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Application Form
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* Indicates required question
Full name
*
Your answer
Email
*
Your answer
Phone number
*
Your answer
First line of address
*
Your answer
Postcode
*
Your answer
Does a member of your household claim any of the following benefits? (select all that apply)
*
Choose
Child Tax Credits
Employment & Support Allowance
Housing Benefit
Income support
Job Seekers Allowance
Pension Credit Guarantee Credit
Pension Credit Savings Credit
Universal Credit
Working Tax Credit
Child Benefit
No
What is the main heating type of the property?
*
Choose
Gas Boiler
LPG Boiler
Oil Boiler
Electric Boiler
Electric Panel Heaters
Electric Storage Heaters
Air Source Heat Pump
Solid fossil fuel burner (logs or coal)
Other heating type
No heating present
What type of grant are you interested in? (All are free of charge)
*
Type of grant you are interested in (check all that apply)
Internal Wall Insulaiton
Room in Roof Insulation
Loft Insulation
Underfloor Insulation
Air Source Heat Pump
Solar Panels
Battery Storage
Anything I am Eligible For
Required
What is the Ownership Status of your property?
*
Choose
Homeowner
Private Tenant
Local authority / Housing association
Landlord
Other
Additional information and comments
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