Northumberland FLEX App

ECO4 and Great British Insulation Scheme Flex: householder

Use this form for households to apply for the ECO4 and Great British Insulation Scheme Flex through their local authority. Completed forms can be sent to Kate Ershadi, Energy Systems Officer at Northumberland County Council. Email: Kate.ershadi@northumberland.gov.uk Telephone: 01670 622275 (Wednesday to Friday) or email energy@northumberland.gov.uk Find out more about the schemes on the Energy Company Obligation (ECO) homeowners and tenants and Great British Insulation Scheme pages of the Ofgem website. If a supplier decides to take your application forward, a retrofit assessor will then determine which of the schemes is suitable, and the specific energy efficiency measures that would benefit your home. 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 or their contracted installer. How to apply

Households should use the tick boxes below to choose one or more of the four routes that they are eligible for. Householder information

Names of every person 18 years living at the address including the householder lodgers and elderly relatives etc

Date

Address

Postcode

Household contact number and email address

example@example.com

Measures: please advise ALL measures to be installed at this address

Qualifying Route

Route 1: Household earnings less than £31kRoute 3: NHS Referral

Client contributions Please detail any client payments required if none state zero

Name of Lead Gen / Surveyor

Job title

Lead Gen / Surveyor Signature

Company

How your personal data is used

The council needs to record personal information about your household, including keeping electronic records. This may also include recording details of health conditions or disabilities. We may also need to share this information with funding energy suppliers, installers, and Ofgem (the administrator for the schemes If you would like more information on how we use your data, please see the council's Privacy Notice available at www.northumberland.gov.uk For details of how any individual or organisation will collect and process your data you should contact them directly. Details of how Ofgem will collect and process your data in connection with the ECO4 and the Great British Insulation Scheme are contained in the ECO privacy notice1 and the Great British Insulation Scheme privacy notice on the OFGEM website.

I understand that this document is not a declaration, and that it will not guarantee my eligibility for ECO4 or GBISI understand that the availability of ECO4 and Great British Insulation Scheme funding and measures will be subject to a retrofit coordinator and that Northumberland County Council does not endorse any specific provider or contractor.I understand that the agreement to install energy measures is between the obligated energy supplier or their contracted installer and the householder. Signing this declaration does not constitute an agreement with Northumberland County Council.I certify that the information I provide about my financial and personal circumstances is true and correct. I understand that Northumberland County Council will require evidence to substantiate this claim.I have provided evidence to support eligibility and agree that this information can be held as required for Ofgem audit purposes until the final determination of ECO4 plus 3 years as a minimum.

Customer Signature

Date