Wolverhampton Council (CWC)

ECO4 FLEXIBLE ELIGIBILITY APPLICATION FORM Wolverhampton Council (CWC)
City of Wolverhampton Council (CWC) have issued a Statement of Intent setting out a set of criteria for the ECO4 Flexible eligibility.

This statement can be found atwww.wolverhampton.gov.uk/housing/financial-help/eco

In order to qualify for assistance under the Government's ECO4 Flex residents must:

Be an owner/occupier (with or without a mortgage) with an SAP rating band D-G or Rent from a private landlord with an SAP rating band E-G and Be eligible under one of the four ECO Flex routes set out in the Councils Statement of Intent.

Please do not complete this form if the applicant is in receipt of means tested benefits. As ECO will apply. For further information on ECO eligibility visit www.ofgem.gov.uk/environmental- programmes/eco/support-improving-your-home

It is the householders and/or the ECO installer acting on behalf the householder responsibility to ensure ALL evidence is provided for the route selected.

Declarations will not be issued until ALL evidence has been provided and verified by City of Wolverhampton Council. Applications will be processed in 10 working days from receipt of email.

Applicants Details
Name

First NameLast Name
Date of Birth

DayMonthYear
Date
Address
Postcode
Phone Number
Email
example@example.com
Partners Details (if applicable)
Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Number of Bedrooms
Property Type

HouseFlatBungalowMaisonette
Property Subtype

DetachedSemi DetachedMid TerraceEnd Terrace
Property Age (if known)
Does your property have a pre-paid meter?

yesno
Number of persons over age 18 with permanent residence at the above dwelling
Number of children with permanent residence at the above dwelling
Household income details

Only Adults
Household member 1:
Name
Income (£ Before Tax)
Frequency (eg. weekly, monthly, yearly)
Source of income (eg. PAYE, self employment, pension)
Evidence provided (eg. payslips/bank statements/tax return)
Household member 2:
Name
Income (£ Before Tax)
Frequency (eg. weekly, monthly, yearly)
Evidence provided (eg. payslips/bank statements/tax return)
Source of income (eg. PAYE, self employment, pension)
Household member 3:
Name
Income (£ Before Tax)
Frequency (eg. weekly, monthly, yearly)
Evidence provided (eg. payslips/bank statements/tax return)
Source of income (eg. PAYE, self employment, pension)
Upload Proof of Earnings

Cancelof
I hereby declare, I am the householder and the information I have provided along with supporting evidence is true.

I understand that City of Wolverhampton Council is not involved and is not responsible for the decisions on funding, the issuing of funding, appointing contractors, installing works or checking the quality of works undertaken. I understand that City of Wolverhampton Council accepts no responsibility or liability for the standard of work carried out, any damage or loss arising from works undertaken or connected to the survey or preparation prior to a grant. I understand that a declaration being issued by City of Wolverhampton Council will not guarantee the installation of my improvements as the final decision will be with the energy supplier. I understand that details provided and supporting evidence will be used by City of Wolverhampton Council, BEIS and Ofgem to process this application.
ROUTE 3- NHS REFERRAL
Signed

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FULL NAME
Date

MonthDayYear
Date
The City of Wolverhampton Council use your data for processing your application. All information is processed in accordance with our organisational data protection privacy policy, which is available on our website. We never sell your data to third parties or use it for marketing purposes without your consent. Information and evidence will be held inline BEIS and Ofgem guidance for the period of the scheme and for a period after the closure of the scheme for audit and fraud prevention purposes, as outlined in ECO Flex guidance.
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ECO4 FLEXIBLE ELIGIBILITY APPLICATION FORM Wolverhampton Council (CWC)

Partners Details (if applicable)

Household income details