Dudley

Dudley Council FLEX Application
ECO4 Flexible Eligibility Statement of Intent for Dudley Metropolitan BoroughDudley CouncilMetropolitan Borough Council Date of publication: 8th September 2022 Version 1

https://www.dudley.gov.uk/energyadvice

The information provided on this form will be used by Dudley Metropolitan Borough Council to assess eligibility for an ECO4 Flex Declaration. A Declaration confirms eligibility to apply for ECO funding from any ECO provider. Availability of ECO funding will be subject to a technical survey of the property and may not cover the full cost of the works. The council does not endorse any specific ECO provider or contractor.

To be completed by Householder

I certify that the information I provide about my financial and personal circumstances is true and correct and that the assessor will require evidence to substantiate this claim.I give consent to the processing sharing and storing of any personal information provided in compliance with Data Protection Law and Dudley Council's Home Improvement Service privacy notice. You can find out more about how we use your information at: https://www.dudley.gov.uk/privacy-disclaimer-statement/place-directorate-dudley- home-improvement-service-privacy-notice/
Name of Householder

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
State names of all adults in the household and the relationships to the above:
Phone Number
Email
example@example.com
Referral Route

Route 1- Household earnings less than £31,000 before taxRoute 3- NHS Referral
Upload Proof of earnings

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Dudley Council FLEX Application