Combined Application

First Name*

Last Name*

Phone*

Email*

Postcode*

Council Tax Band*
Select Your Council Tax BandABCDE (Scotland Only)Not Sure

Property Type*
Select Property TypeFlatMaisonetteTerraced HouseSemi-Detached HouseDetached HouseBungalow

Tenure*
Select TenureOwner OccupiedPrivate RentedHousing AssociationCouncil

Number of Bedrooms*
Select Number of Bedrooms123456+

Energy Performance Certificate (EPC) Rating*
Select EPC RatingDEFGNot Sure

Household Income*
Select Income BandUnder £20,000£20,000 - £31,000£31,000 - £40,000£40,000+

Benefits Claimed (Select all that apply):*
Child Tax CreditWorking Tax CreditUniversal CreditPension Guarantee CreditPension Savings CreditIncome SupportIncome-based Jobseeker's Allowance (JSA)Income-related Employment and Support Allowance (ESA)Housing BenefitNone

Heating Type (Select all that apply):*
Mains Gas BoilerElectric HeatersOil BoilerSolid Fossil FuelLPGNoneNot Sure

What insulation does your property currently have? (Select all that apply):*
Loft InsulationCavity Wall InsulationSolid Wall InsulationNot Sure

Health Conditions (Select all that apply):*
AsthmaCOPDHeart DiseaseDiabetesHypertensionStrokeCancerArthritisKidney DiseaseMental Health ConditionOtherNone