Form 1 EVHS Survey and Consultation

EVHS Survey and Consultation

Form 1
Customer Name (registered keeper of the vehicle)

First Name Last Name
Address

Street Address

Street Address Line 2

City County

Post Code
Address Map Locator
Contact Number
E-mail
Eligibility Questionaire
Property requirements

The customer must be resident at the property. This will be checked via vehicle registration details. Where the link between the customer and the property is unclear, additional supporting evidence may be required (for example, a utility bill).

Any necessary third-party permissions (such as from a freeholder or managing agent of a block of flats) must be obtained by the customer before an installation occurs. This will be needed for rented or leasehold properties where it’s the renter or the leaseholder applying.

Where an installation requires cabling or other parts of the installation to be placed in or on another person’s property, or public land, access rights and permissions must be agreed by all parties using legally binding arrangements, such as legal covenants, before an installation begins.
Please read and acknowledge the above by ticking the appropriate option for your property or place of installation *

Property owner / Resident Private tenant / Resident Business premises Other
The customer’s property (meaning, the installation address) must have designated, private off-street parking. This may be co-located with the property or separate from it. Where the parking is separate the customer must be able to demonstrate that they have a legal entitlement to the parking space through the provision of land registry title deeds.

The parking must be suitable for a chargepoint installation (a survey before installation must be conducted by the installer). The parking must be able to permit an eligible vehicle to be charged safely. The customer must be able to access the parking space at all times.
Does your property have dedicated off street parking? *
Eligible vehicles

To be eligible for the grant the vehicle must be listed on the EVHS eligible vehicles list at the time of installation. The list includes battery electric and plug-in electric cars, vans, taxis and motorcycles.
Make and model of your vehicle *
Vehicle Registration Number
If already owned
Vehicle Ownership Requirements - please indicate which is applicable *

individuals who become registered keepers of a new or second hand eligible electric vehicle - note that the registered keeper is not necessarily the owner of a vehicle, but the person responsible for the car that pays for road tax and MOT individuals can claim for a second chargepoint if they own two eligible electric vehicles concurrently individuals who are assigned a company car for at least 6 months individuals who lease an eligible vehicle for at least 6 months individuals who lease an eligible electric vehicle through a salary sacrifice scheme individuals who are named, by their employer, as the primary user of an eligible electric vehicle for at least 6 months individuals who have ordered an eligible electric vehicle
Do you have legal ownership or right to use the vehicle for at least six months? *
please specify
Survey

Please upload photos showing 1. the location of the consumer unit (fuse board), 2. a close up view of the consumer unit (fuse board) with the door open, 3. the location of the electricity meter cabinet in relation to the property, 4. a close up of the meter cabinet (with door open), 5. the front of your property with the preferred location of your EV chargepoint and 6. a simple floor plan of your house showing the location of the consumer unit (fuse board) Example photos below:
Your survey photos *

Please upload your photographs here
Cancel of
Explanatory notes
E.g. Location of electricity meter, preference for siting of EV chargepoint
Electricity Supply Number (MPAN)
The Electricity Supply Number can be found on your electricity bill. The MPAN starts with 20 and is 13 digits long
Adequacy of supply assessment

to assess how adequate the electricity supply capacity is for the new electric vehicle load plus any existing load.
INSTALLER ONLY. Adequacy of supply assessment
Chargepoint Selection

Please identify any preference for chargepoint.
Chargepoint model
Please mark unspecified if you would like our advice
Signature

Clear
Date

Day Month Year
Should be Empty:

EVHS Survey and Consultation

Eligibility Questionaire

Survey

Chargepoint Selection