You can always press Enter⏎ to continue
Energy Tree ECO4 Eligibility Form!
Find out if you're eligible for your FREE Government Grant Today!
START
1
Full Name
*
This field is required.
First Name
Last Name
Previous
Next
Submit
Press
Enter
2
Address
*
This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Previous
Next
Submit
Press
Enter
3
Phone Number
*
This field is required.
Enter +44 in 'Area Code'
Area Code
Phone Number
Previous
Next
Submit
Press
Enter
4
E-mail
example@example.com
Previous
Next
Submit
Press
Enter
5
What is your current tenure?
*
This field is required.
Please Select
Homeowner
Privately Renting
Social Housing Rented
Please Select
Please Select
Homeowner
Privately Renting
Social Housing Rented
Previous
Next
Submit
Press
Enter
6
What is your current EPC rating?
*
This field is required.
Previous
Next
Submit
Press
Enter
7
Is there gas connection to the property?
*
This field is required.
YES
NO
Previous
Next
Submit
Press
Enter
8
Was your gas meter installed before 31st March 2022?
*
This field is required.
Yes
No
Not Sure
Previous
Next
Submit
Press
Enter
9
What is your current main heating system
*
This field is required.
Electric underfloor heating
Electric storage heaters
Gas central heating from boiler
Gas fire / back boiler
Solid fossil fuel fire / open fire
Bottled LPG Heating
Wood/biomass heating
Oil heaters
No heating in place
Not Sure
Previous
Next
Submit
Press
Enter
10
Secondary heating system
*
This field is required.
Electric panel or oil room heater
Solid fuel fires
Storage heaters
Not sure
Previous
Next
Submit
Press
Enter
11
What is your boiler type?
*
This field is required.
Combi Boiler
Condenser Boiler
1960 to 1980 Back Boiler
Other / Not sure
Other
Previous
Next
Submit
Press
Enter
12
If known, enter year of installation (optional)
-
Date
Year
Month
Day
Previous
Next
Submit
Press
Enter
13
Do you have a separate hot water cylinder? (Optional)
YES
NO
Previous
Next
Submit
Press
Enter
14
Does the property have a room in loft? (Optional)
YES
NO
Previous
Next
Submit
Press
Enter
15
Is the loft insulated? (Optional)
YES
NO
Previous
Next
Submit
Press
Enter
16
What is your property type?
*
This field is required.
Detached
Semi-Detached
Mid Terrace
Maisonette
Bungalow
Flat
Previous
Next
Submit
Press
Enter
17
What is the wall type?
*
This field is required.
Solid brick wall
Cavity wall
Stone wall
Unsure / Other
Previous
Next
Submit
Press
Enter
18
Do you have any wall insulation?
*
This field is required.
Filled Cavity
External wall insulation
Internal wall insulation
No insulation / Unsure
Previous
Next
Submit
Press
Enter
19
Select the Benefit You Are Receiving
*
This field is required.
Child Tax Credits (CTC)
Child Benefits - depends on income threshold
Jobseekers Allowance (JSA)
Employment & Support Allowance (ESA)
Income Support (IS)
Pension Credit Guarantee Credit
Universal Credit (UC)
Warm Home Discount Scheme Rebate
Working Tax Credit (WTC)
Housing Benefit
Pension Credit Saving Credit
Other
Previous
Next
Submit
Press
Enter
20
If you claim another benefit that is not featured on the list above, please put it in the box below.
Previous
Next
Submit
Press
Enter
21
Does your household earn less than 31k per year?
YES
NO
Previous
Next
Submit
Press
Enter
22
Does anyone in your household have a severe or long-term health condition that is adversely affected due to living in a cold or damp home?
Please select health condition below
Asthma (worsened symptoms or increased risk)
Respiratory Infections (such as bronchitis or pneumonia)
Rheumatoid Arthritis (increased joint pain and stiffness)
Hypothermia (particularly for elderly individuals)
Chronic Obstructive Pulmonary Disease (COPD) (enhanced severity of symptoms)
Fungal Infections (especially in immunocompromised individuals)
Mental Health Issues (increased risk of depression and anxiety)
Cardiovascular Strain (heightened risk for heart disease and hypertension)
None of the above
Prefer not to say
Previous
Next
Submit
Press
Enter
23
Please upload an image of the following if possible.
Boiler - Gas Meter - Electric Meter
Drag and drop files here
Select files to upload
Max. file size
: 10.6MB
Browse Files
Cancel
of
Previous
Next
Submit
Press
Enter
24
Please give reference of any two people whom you feel may be eligible for the ECO4 Grant:
Full Name
Address
Contact Number
1
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
2
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
1
2
Full Name
Row 0, Column 0
Address
Row 0, Column 1
Contact Number
Row 0, Column 2
Full Name
Row 1, Column 0
Address
Row 1, Column 1
Contact Number
Row 1, Column 2
1
of 2
Previous
Next
Submit
Press
Enter
25
SEP ENERGY SOLUTIONS
5 Hattersley Court, Ormskirk Lancashire, L39 2AY
Previous
Next
Submit
Press
Enter
Should be Empty:
Question Label
1
of
25
See All
Go Back
Submit
