Leicestershire County Council FLEX Application

Green Living Leicestershire - ECO4 & GBIS Flexible Eligibility Application Form

This form is for households to apply for the ECO4 (Energy Company Obligation) & GBIS (Great British Insulation Scheme) Flexible Eligibility route via LeicestershireCounty Council’s Warm Homes Service and Green Living Leicestershire.
Password*
Name of Representative *
I confirm that to the best of my knowledge, the information provided by the applicant is true and correct and that the household is eligible for Eco Flex
Representative Signature*

Clear
This application does not guarantee eligibility for ECO4 or Great British Insulation Scheme Flex, and all applications are subject to assessments carried out by the local authority and an energy supplier.

IMPORTANT NOTICE:

Leicestershire County Council does not oversee or manage the ECO & GBIS scheme. Leicestershire CountyCouncil are NOT in partnership or endorse any works carried out by installation companies or requirefurther vetting of installation companies. To cancel an application the applicant will need to contact theinstaller and NOT Leicestershire County Council.

For more information regarding the Energy Company Obligation (ECO) homeowners and tenants and GreatBritish Insulation Scheme, please visit the Ofgem website Here:

https://www.ofgem.gov.uk/environmental-and-social-schemes/energy-company-obligation-eco/homeowners-and-tenants or here: https://www.ofgem.gov.uk/environmental-and-social-schemes/great-british-insulation-scheme
Applicant Details
Name*
Address*
Postcode*
Telephone*
Email
example@example.com
Tenure
Tenure*

Owner OccupiedPrivate Rented
Tenure evidence supplied

Land Registry EntryDeeds or mortgage statement dated within the last 12 months(If Land Registery Entry is unavailable)Relevant OFGEM template (If none of the above are available)Private rented,Tenancy agreement PLUS landlords permission form
Property EPC Rating

D (homeowners only)EFG
EPC Evidence Provided

Most recent EPCMost recent EPR
Household Details
Number of ADULTS in the property*
Number of CHILDREN in the property*
Proof of Number of Occupants Provided

Council Tax LetterTenancy AgreementMost Recent Mortgage Statement
Qualifying Route
Which FLEX qualifying route?*

Route 1 - household income less than £31,000 before taxRoute 3 - NHS referral
Route 1: What is the household income before tax?
What evidence are you suppling?

Tax Return: (for self-employed/sole traders or business owners completingHMRC self – assessments) Tax return must be dated within the last 6 months,(if older the 6 months, then the tax return must be accompanied by anadditional source listed)3 Payslips alongside bank statements dated within the last 3 monthsP45 dated within the last 3 months accompanied by an additional sourcelistedP60 for each job/pension
Measures
Which energy efficiency measures are being considered for this property (tick all that apply)?*

Loft insulationCavity wall insulationInternal wall insulationGas boilerFirst time gas central heatingHeating controlsESH upgradeSolar PVASHP
Data Protection and Privacy Statement
The data on this form is collected for or on behalf of Leicestershire County Council to assess your eligibility forassistance under Energy Company Obligation (ECO) and/or Great British Insulation Scheme (GBIS) Flexible Eligibility.

By completing this application, you will not automatically receive assistance for measures, as ECO/GBIS Flexible Eligibility assistance is provided by energy suppliers not Leicestershire County Council.

The information provided to Leicestershire County Council in this form will be held securely and used for ECO/GBIS Flexible Eligibility purposes. The information may also be used and shared with other organisations (funding energysuppliers, installers, and Ofgem (the administrator for the schemes)), if necessary, to protect public funds and/or toprevent fraud. For details of how any individual or organisation will collect and process your data you should contactthem directly.

Details of how Ofgem will collect and process your data in connection with the ECO4 and the Great British InsulationScheme are contained in the ECO privacy notice and the Great British Insulation Scheme privacy notice on the OFGEM website.

The information will be held securely in electronic format by Leicestershire County Council. The evidence for meetingthe eligibility criteria and the application form will be kept for not longer than seven years and then deleted in line with current data protection legislation.

Declaration

By signing this form, I certify that the information detailed on this form relating to me and my financial/personalcircumstances is true and correct. I understand that the Leicestershire County Council will require evidence tosubstantiate this claim. By signing this form, I consent to my personal data (including relating to my health condition) being provided to, used, and stored by Leicestershire County Council for the following purposes:

• processing this application form to confirm my eligibility for this scheme.

• internal performance review, analysis, reporting and audit to improve our services; and

• contacting me for application verification, customer satisfaction purposes and to see whether I’d be willing toparticipate in future promotional activity
I understand that this document is not a declaration, and that it will not guarantee my eligibility for ECO4 or Great British Insulation Scheme Flex measuresI understand that the availability of ECO4 funding and measures will be subject to a retrofit coordinator and thatLeicestershire County Council does not endorse any specific ECO provider or contractor/in
Signature*

Clear
Date

DayMonthYear
Date
Dropbox Folder
Should be Empty:

Green Living Leicestershire - ECO4 & GBIS Flexible Eligibility Application Form

Applicant Details

Tenure

Household Details

Qualifying Route

Measures

Data Protection and Privacy Statement