Heating and Insulation Application

1Your Home

2Your Benefits

3Tax Credit Details

4Universal Credit Details

5Child Benefit Details

6Application Failed

7Your Details

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Postcode:*

Please select your house type:*

Number of bedrooms that your home has:*

Do you have a room in your loft or attic with a fixed staircase and a window?*

Property Age:*

Please enter a number from 1 to 150.

Is your boiler over 15 years old?*

Yes: Boiler is over 15 years old

No: Boiler is not 15 years old

Unknown: Boiler age is not known

Select your type of Boiler:*

Gas

Electric

LPG

Oil

Solid Fuel

* Solid Fuel systems will be replaced with a brand new LPG or Natural Gas solution.

Describe any boiler issues:*

Does your property have Loft insulation?*

Yes

Don’t know

Does your property have Cavity Wall insulation?*

Yes

Don’t know

Housing Status*

I am the owner of my property

I am a private tenant, renting a property

What is your current ECP rating?*

None

Benefits Received

Which of the below benefits do you receive?

Benefits Received*

I receive: A) Income Related Employment and Support Allowance

I receive: B) Income Based Job Seekers Allowance

I receive: C) Income Support

I receive: D) State Pension Credit (In receipt of Pension Credit Guarantee Credit or both Guarantee Credit and Savings Credit)

I receive: E) Tax Credits

I receive: F) Universal Credit

I receive: G) Child Benefit

I receive: H) Disability Living Allowance

I receive: I) Personal Independence Payment

I receive: J) Attendance Allowance

I receive: K) Carer’s Allowance

I receive: L) Severe Disablement Allowance

I receive: M) Industrial Injuries Disablement Benefits

I receive: N) War Pensions Mobility Supplement

I receive: O) Constant Attendance Allowance

I receive: P) Armed Forces Independence Payment

I receive: Q) Working Tax Credits

I do NOT receive any of the above benefits (you must receive a listed benefit to qualify, see details here)

Tax Credits

Because you mentioned you receive Tax Credits, we need a little more information from you.

Who lives in your house?*

Is your gross annual income less than £13,200?*

Yes

Is your gross annual income less than £17,400?*

Yes

Is your gross annual income less than £21,600?*

Yes

Is your gross annual income less than £25,800?*

Yes

Is your gross annual income less than £30,000?*

Yes

Is your gross annual income less than £19,800?*

Yes

Is your gross annual income less than £24,000?*

Yes

Is your gross annual income less than £28,200?*

Yes

Is your gross annual income less than £32,400?*

Yes

Is your gross annual income less than £36,600?*

Yes

Universal Credit

Because you mentioned you receive Universal Credit, we need a little more information from you.

Who lives in your house?*

Is your net, monthly income less than £1,100?*

Yes

Is your net, monthly income less than £1,450?*

Yes

Is your net, monthly income less than £1,800?*

Yes

Is your net, monthly income less than £2,150?*

Yes

Is your net, monthly income less than £2,500?*

Yes

Is your net, monthly income less than £1,650?*

Yes

Is your net, monthly income less than £2,000?*

Yes

Is your net, monthly income less than £2,350?*

Yes

Is your net, monthly income less than £2,700?*

Yes

Child Benefit

Because you mentioned you receive Child Benefit, we need a little more information from you.

Are you a single claimant?*

Is your net, yearly income less than £18,500?*

Yes

Is your net, yearly income less than £31,000?*

Yes

Is your net, yearly income less than £27,500?*

Yes

Is your net, yearly income less than £32,000?*

Yes

Is your net, yearly income less than £25,500?*

Yes

Is your net, yearly income less than £30,000?*

Yes

Is your net, yearly income less than £34,500?*

Yes

Is your net, yearly income less than £39,000?*

Yes

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Application Failed

Unfortunately it seems you don’t qualify for the scheme, however you can still get the benefits of a brand new boiler. Please wait whilst we redirect you.

GREAT NEWS! Our records INDICATE that you could be eligible for a new boiler absolutely FREE! Simply enter your contact details below and one of our team will be in touch.

Title:*

Your date of birth:*

Day

Month

Year

Your full name:*

Your telephone number:*

Your email address:*

Your full address*

Street Address City County Post Code

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Heating & Insulation application form

Benefits Received

Tax Credits

Universal Credit

Child Benefit

Application Failed