First Name*
Last Name
Email Address*
Phone Number*
Address Line 1*
Address Line 2
City*
State / Province / Region*
Postal Code*
Country*
Your Option of Heating available with the Funding?* High Heat Electric Storage HeatersFirst Time Central HeatingAir Source Heat PumpsSolar PV
Your option of insulation with the funding* External wall insulationInternal wall insulationRoom in Roof insulationPitched Roof insulationLoft insulationUnderfloor insulationFlat roof insulation
What is your Tenure?* HomeownerPrivately RentingSocial Housing Rented
Is there Gas connection to the property?* YESNo
What is your EPC Rating?* ABCDEFG
Was your gas meter installed before 31st March 2022?* YESNo
What is your current heating system?* Electric: underfloor / ceiling heatingElectric: Directional, fan or storage heatersGas: Fixed mains gas heaters (Not Central Heating from Boiler)Gas fire / back boilerSolid fossil fuel fire / back boiler / heatersBottled LPG HeatingWood/biomass heatingOil heatersNo heating in place
Select the Benefit You Are Receiving?* Child Tax Credits (CTC)Child Benefits - depends on income threshold.Jobseekers Allowance (JSA)Employment & Support Allowance (ESA)Income Support (IS)Pension Credit Guarantee CreditUniversal Credit (UC)Warm Home Discount Scheme RebateWorking Tax Credit (WTC)Housing BenefitPension Credit Saving Credit
Child Benefit Income Test* Please SelectHousehold income-maximum levelsingle adult with 1 child: £19,900single adult with 2 children: £24,800single adult with 3 children: £29,600single adult with 4 or more children: £34,500Couple with 1 child: £27,500Couple with 2 children: £32,300Couple with 3 children: £37,200Couple with 4 or more children: £42,000
