HUG 2 Application Form

Home Upgrade Grant

Application Form
Please be aware that this form refers to properties that do NOT use gas for heating. If your property uses gas, please complete the form here: https://www.nottenergy.com/self-referral-form.
Tell us about yourself

Please complete this form so we can understand your property, financial and personal circumstances better. We can then determine your eligibility for this scheme.
Which services are you interested in?

Loft InsulationWall InsulationRenewable EnergyBoiler / Heating HelpHealth & Wellbeing Help i.e. Fuel Vouchers or Home Adaptations (mobility aids)Help with debt, benefits and/or your water billOther
1. Personal Details
Title*
Name*

First NameLast Name
Date of birth*

DayMonthYear
Telephone Number*
Email*
House Number/Name*
Street/Road*
Area*
County*
Postcode*
Who's your Local Authority?*
What's your Nationality?*
What's your monthly household income (before any deductions)?
Do you have any savings?

Home Upgrade Grant