North East Lincolnshire Council Flex Application

North East Lincolnshire Council ECO4 and GBIS LA Flex Application
Password*
Names & Age of All Adult Occupants
Occupant 1 Name & Age*
Occupant 2 Name & Age
Occupant 3 Name & Age
Occupant 4 Name & Age
Tick here if you're the sole occupant of the property
Address Line 1*
Address Line 2
Town/City*
Postcode*
Phone number*
Email*
example@example.com
Tenure*

Owner OccupiedPrivate Rented
EPC Rating - Owner Occupied

DEFGNO EPC
EPC Rating - Private Rented

DEFGNO EPC
Which FLEX route?

Route 1 - household income less than £31,000Route 3 - NHS Referral
Which FLEX referral route?*

Route 1 - gross household income less than £31,000Route 3 - NHS Referral
Please list all measures to be installed*
eg. boiler replacement, loft insulation, cavity wall insulation etc
Installer
intuECO Ltd, Charlotte House, Stanier Way, Wyvern Business Park, Derby. DE21 7BF

Trustmark License Number: 3619630
No client payments*
I/we would like to request a declaration from North Tyneside Council that I/we meet the eligibility criteria set out in the Local Authority Flexible Eligibility Statement of Intent for the purpose of accessing funding from the Energy Company Obligation (ECO4)*

I/we understand that the agreement to install energy measures is between the ECOcontractor and the householder. Signing this declaration does not constitute anagreement with North East Lincolnshire Council.I/we confirm that we meet the eligibility criteria and that all the information on the verification form overleaf is correct.I/we have provided evidence to support eligibility and agree that this information canbe held as required for Ofgem audit purposes until the final determination of ECO4 plus 3 years as a minimum.
Main Applicant Signature*

Clear
Occupant 2 Signature (if applicable)

Clear
Date

DayMonthYear
Date
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 other organisations for audit purposes
Dropbox Folder
Should be Empty:

North East Lincolnshire Council ECO4 and GBIS LA Flex Application

Names & Age of All Adult Occupants