East Lindsey District Council ECO4 Flex householder application

East Lindsey District Council ECO4 & GBIS LA FLEX Application

Password*

Name of householder(s)*

If there's more than one occupant, all names need to be listed here

Address*

Postcode*

Email address*

Household contact number*

Which FLEX Route?*

Route 1 - household income less than £31,000Route 3 - NHS Referral

I / we understand that I/we may be eligible for the ECO Flex scheme as detailed on the next page. Please confirm the following statements by ticking in the relevant boxes and sign where indicated.

I give consent for the information provided on this form to be used by East Lindsey District Council to assess my eligibility for an ECO Flex Declaration. I understand that this document is not a declaration, and that it will not guarantee my eligibility for ECO Flex measures.I understand that the availability of ECO4 funding and measures will be subject to a retrofit coordinator and that East Lindsey District Council does not endorse any specific ECO provider or contractor.I certify that the information I provide about my financial and personal circumstances is true and correct. I understand that East Lindsey District Council will require evidence to substantiate this claim.I give East Lindsey District Council permission to share my contact and personal details with third parties to assess whether a contribution is available.

Householder 1 signature*

Householder 2 signature (if applicable)

Householder 3 signature (if applicable)

Householder 4 signature (if applicable)

Date*

Date

Dropbox Folder