ENERGY FUEL FUND 23-24

ENERGY FUEL FUND 23-24
To be eligible for support from this fund*, households must be facing financial pressures, be at risk of self-disconnection and have a pre-payment meter. Referrals must come from social landlords registered with the scheme.

*Please note this is an external fund and is not administered by NHG. Funds are subject to availability.

Evidence required for eligibility

We require a photo of your pre-payment meter together with one of the following:

1) A copy of a rent statement showing arrears or

2) A benefits letter (for means-tested benefits) or

3) A completed income and expenditure assessment.

If you have any questions please email tenancysupport@nhg.org.uk
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

City

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
How many people live in your home?*
Do you have a disability ?*

YesNo
Have you received any of the following support?

Further energy adviceFinancial support e.g. debt or benefit adviceHealth and wellbeing supportN/a
Which age category do you fall into?

16-2425-3435-4950-6465-7475+
Which best describes your ethnicity?

Asian, Asian British or Asian WelshBlack, Black British, Black Welsh, Caribbean or AfricanGypsy, Irish Traveller or RomaMixed or Multiple ethnic groupsWhiteOther ethnic group
Are you receiving means-tested benefits?
Please confirm if you top up via pre-payment meter (this does not include smart meters)*
Employment status

Full-time workPart-time workRetiredUnemployedFull-time educationOther inactive
Please confirm if you top up via Pay Point*
This fund is only available to non British Gas customers*
Evidence of eligibility (part 1): Please upload a picture of your pre-payment meter*

Cancelof
Evidence of eligibility (part 2). Please attach one of the following: (i) Evidence of rent arrears (i.e. rent statement) OR (ii) evidence of benefits/UC entitlement. If neither apply to you please see the next box. *

Cancelof
If you are not inreceipt of means tested benefits and are not in rent arrears, you will need to complete an income and expenditure form for consideration. Please answer one of the following:

Yes please send me an income and expenditure form.I do not wish to proceed with this application.I need support, please contact me.
Are you completing this form on behalf of someone else?*

YesNo
If you are completing this on behalf of someone else, please state your name*

First NameLast Name
If completing on behalf of someone else, please confirm you have received consent from the resident to share their information with a third party- see data sharing statements below.*
Please state the date you obtained consent *

DayMonthYear
By ticking this box and submitting this form you are consenting to all of the data you have inputted into this form to be sent to Notting Hill Genesis Housing association and an external fund administered by HACT . If you change your mind, you can withdraw consent at any time by contacting your Housing Officer. *
I consent to Notting Hill Genesis submitting an application on my behalf to HACT, for this external grant towards energy costs and in relation to financial hardship.*

Yes
I consent to Notting Hill Genesis providing any or all of the following as required by the eligibility criteria of the external funding sourced: a copy of rent statement, showing the balance - submission of proof of benefit entitlement (as provided by myself)- photos of energy pre-payment meter readings as required, Income and expenditure forms or a letter confirming I have received Money Advice (as provided by myself).*

Yes
I understand that: my data will be held in accordance with the General Data Protection Regulation*

Yes
Should be Empty: