Eligibility Form

Home Owner Tenant (Private) Lives with home owner (sub-let) Council House (Not eligible) Housing Association/Social Housing (Not eligible)

Income-based job seeker’s allowance (JSA) Employment and support allowance (ESA) Pension Guarantee Credit Working tax credit (WTC) Child Tax Credit (CTC) Universal Credit (UC) Income support allowance (ISA) Housing Benefit Pension Savings Credit Child Benefit Flex (disable, sick etc.) Other No Benefits

Apartment/Flat Bungalow Detached House Semi-Detached House Terraced House Mid-Terraced House Static Park Home (not eligible)

1 bedroom 2 bedrooms 3 or more bedrooms

Before 1900 1900-1930 1930-1980 1980-2005 After 2005

Electric heating Oil boiler Warm air boiler LPG boiler Back boiler Coal Solid fuel No Heating Others

Installed before 2005 2006-2010 After 2010 Not sure No Boiler/Radiator Installed

Free External Wall Insulation Free Internal Wall Insulation Free Cavity Wall Insulation Free Loft Insulation Free Solar Installation Free Central Heating Installation Free Heat Pump Installation Free Boiler Replacement Other