1 EPC Rating 2 Home Info 3 Personal Info 4 Property Details Step 1: EPC Rating What is your EPC rating? (Click here if you don't know) --Select EPC Rating-- A B C D E F G+ Not sure Next Step 2: Home & Benefits Information What is your home ownership status? --Select Status-- Home Owner Private Tenant Council Tenant Housing Association Tenant Please select the main benefit currently received within the home: --Select Benefit-- Pension Credit Child Benefit Child Tax Credit Working Tax Credit Universal Credit Income Support Income-related Employ Support Allowance (ESA) Income-based Job Seekers Allowance (JSA) Disability Living Allowance (DLA) War Pensions Mobility Supplement Industrial Injuries Disablement Benefit House-hold income less than £31,000 None of the above Previous Next Step 3: Personal Information Full Name: Email Address: Contact Number Postcode: Address Line 1: Address Line 2 (optional): Town/City: Previous Next Step 4: Property Details What is the main fuel used to heat this property? --Select Fuel Type-- Main Gas Oil LPG Electric Storage Heater Storage Fuel No Heating Source Approximately, when was your property built? --Select Property Age-- Before 1930 Between 1930 - 1980 Between 1980 - Present Don't Know How old is your boiler? --Select Boiler Age-- More than 20 years old Less than 20 years old No Existing Boiler Is your boiler located behind a fireplace (also known as a back boiler)? --Select Option-- Yes No Not Sure / No Boiler Has either wall or loft insulation been added to the property within the last 10 years? --Select Option-- Yes No Not Sure Previous Submit
