EVHS

Electric Vehicle Homecharge Scheme Installation Form

Note for vehicle registered keepers/primary users

The Electric Vehicle Homecharge Scheme is a government-funded scheme to support the roll-out of home charging equipment for plug-in vehicles at domestic properties. Please note that the scheme is funded by tax payers’ money. You are the beneficiary of this grant which will be claimed on your behalf by your installer Please be sure that costs are not being exaggerated or inflated by your chosen chargepoint installer. OLEV will run audit checks and if any claim is found to be false, payment will be refused or will have to be repaid. The contents of this form must not be altered without prior permission from OLEV under any circumstance. Your personal information will be safeguarded and processed in accordance with data protection legislation. The Department for Transport is the ‘Controller’ for personal data processed as part of the Electric Vehicle Homecharge Scheme (EVHS) and the Workplace Charging Scheme (WCS). A copy of the full Privacy Policy, which includes the information we collect, how we use it and under what circumstances, if any, we will share it with other parties, is available at: https://www.gov.uk/government/organisations/office-for-low-emission-vehicles

READ BEFORE COMPLETING FORM...

As well as the completion of this form you may be required to provide some 'Proof of Ownership' for the vehicle being claimed for. Below are examples of the documentation required for different situations.

Please make sure you either have the relevant documentation available as a file to upload or, if using a mobile device, you can also take a photo of the document which will then automatically be added to the form.

YOU ARE/HAVE	DOCUMENTATION REQUIRED
Registered Keeper of the vehicle	NONE, Registration Number will suffice.
Ordered the vehicle	Order Confirmation Other Proof of Purchase
Leasing or have Finance	Lease Confirmation Hire Purchase Agreement Contract Hire Agreement Contract Purchase Agreement Motability Document Letter from Leasing Company or Vehicle Provider (MUST have a Company Reg. No. on document)
Company Vehicle	Letter from Employer. ( A Template letter should have been attached to the email)
Leased as part of Salary Sacrifice scheme	Letter from Employer. ( A Template letter should have been attached to the email) Order Confirmation

PART A – REGISTERED KEEPER/PRIMARY USER DECLARATION

Section 1 – Customer Details
1. Name of Primary Vehicle User*
As it appears on their/your driving license ("the customer")
2. Installation Address*
House No. & Street Name
Town / City
Postcode*
3. Telephone Number*
4. Email Address*
5. Vehicle Make & Model*
6. Confirmation vehicle is listed on the OLEV Electric Vehicle Homecharge Scheme eligible vehicles list#

YESNO
Your vehicle MUST be on the list to be eligible for the grant.
# https://www.gov.uk/government/publications/electric-vehicle-homecharge-scheme-eligible-vehicles
7. Vehicle Registration Number (VRN) - IF KNOWN AT THIS TIME
Enter the Vehicle Reg No. if you have it. If the vehicle is on order please leave as NOT AVAILABLE
Section 2 – Proof of ownership of a qualifying vehicle

Please tick ONE of the boxes to confirm your customer type and that you have at least ONE of the matching pieces of evidence.

All documents provided must reference your Name, Address and Vehicle Make & Model.
I AM THE REGISTERED KEEPER OF THE VEHICLE

Tick Box

Vehicle Registration Number (No Documentation Required)

For the sections below, the proof must be official headed documentation providing evidence that you are the user of an eligible electric vehicle for a minimum of 6 months.

Section 3 - Customer Declaration

I confirm that each of the below statements applies to me :-
I am the registered keeper, lessee or nominated user of the vehicle, or have the vehicle on order
I have use of this eligible vehicle for a minimum of 6 months beginning on the date I take keepership or control
I acknowledge that I am required to inform the installer if, before installation of the chargepoint, my circumstances change and I am no longer eligible for the grant
The address specified above is a residential address and is owned or rented by me.
Where the property is a leasehold or is rented, I have consent from the landlord/freeholder for a domestic EV chargepoint to be installed. (If not applicable please leave as YES)
A grant has not been previously claimed at this property by myself or spouse/partner/family member residing at this address under the Domestic Recharging Scheme (ran from FEB13 to AUG14) or EVHS.
OR My household has 2 eligible vehicles and I am claiming a 2nd chargepoint grant for the 2nd vehicle......The existing eligible vehicle (which is NOT the vehicle being claimed for in this application) is a leased/company vehicle or is currently on order, and I will provide additional evidence for this vehicle as listed in Section 2. The VRN of the existing eligible vehicle (which is NOT the vehicle being claimed for in this application) is
Please enter VRN of 2nd vehicle
I have not previously claimed under the Domestic Recharging Scheme or Electric Vehicle Homecharge Scheme for this vehicle
I am having this chargepoint installed as a private individual and will not be claiming the VAT back from HMRC
The installation address has designated off-road parking with good access for the vehicle to be charged safely
Conditions for use of Chargepoint

I confirm I agree with the following conditions of use :-
I am content for API ELECTRICAL LTD to claim the Electric Vehicle Homepage grant on my behalf
I agree to be contacted by the Office for Low Emission Vehicles (OLEV) or it's agents for audit purposes, should my installation be chosen.(your personal information will be safeguarded and processed in accordance with the requirements of data protection law).
I understand that I am responsible for paying the costs associated with electricity usage for the chargepoint.
Customer Declaration

I have read and understood the information outlined. I declare that the information I have given on this form is correct and complete, I understand that OLEV will use all of the information provided on this form and all supporting evidence to assess the claim for Electric Vehicle Homecharge Grant Scheme.

If I knowingly breach any of the above conditions, give information that is incorrect or if relevant information is knowingly omitted in this application, OLEV reserves the right to take whatever action it deems appropriate (including, but not limited to, legal action) to recover from the customer any benefit received in accordance with the EVHS grant and any other associated recovery costs.

Your personal information will be safeguarded and processed in accordance with data protection legislation. The Department for Transport is the ‘Controller’ for personal data processed as part of the Electric Vehicle Homecharge Scheme (EVHS) and the Workplace Charging Scheme (WCS). A copy of the full Privacy Policy, which includes the information we collect, how we use it and under what circumstances, if any, we will share it with other parties, is available at https://www.gov.uk/government/organisations/office-for-low-emission-vehicles
Signature*

Clear
If you are not using a touch screen device the signature can done with the mouse...holding the left-button to write
Date

DayMonthYear
Date
signame

	Tick Box
Vehicle Registration Number (No Documentation Required)

	Tick Box
Provide Order Confirmation
Provide Other Proof of Purchase

	Tick Box
Leasing Confirmation
Hire Purchase Agreement
Personal Contract Hire Agreement
Personal Contract Purchase Agreement
Motability Order or Contract
Letter from Leasing Company or other appropriate party providing use of the vehicle (must include a Company Registration number)

	Tick Box
Letter from Employer (Your letter must include either your employers Company Reg No., VAT Reg No. or a separate letter evidencing HMRC registration confirmation).

	Tick Box
Letter from Employer (Your letter must include either your employers Company Reg No., VAT Reg No. or a separate letter evidencing HMRC registration confirmation).
Order Confirmation

ELECTRICITY SUPPLY NUMBER (MPAN)

We also require your Electricity Supply Number (MPAN) which is usually found on your utility bill. It is either a 13 or 21 digit number, an example is shown below.

Enter your Electricity Supply Number (MPAN)
EVIDENCE DOCUMENTATION

If you have the required evidence available you can either upload the document or take a photo (if using a mobile device).
Click to take photo of evidence....
Click to take photo of evidence....
Upload evidence document...

Browse Files

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Any other information or comments you would like to add, please use the box below
Please take a moment to rate the the user friendliness of this form
Please check your form before submitting as incorrectly completed forms will lead to a delay for installation..(only 1 box should be ticked in Section 2 & all the boxes in Section 3 should be YES).
You cannot Submit this form as you have selected NO on one of the options in Section 3 - Customer Declaration or the Conditions for use of Chargepoint....All MUST be YES to be eligible for grant....Or you have selected NO to your vehicle being on the eligible vehicles list (Section 1 - Question 6)...Please contact us to assist in this matter
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Electric Vehicle Homecharge Scheme Installation Form