NEF FLEX DECLERATION

The National Energy Foundation (NEF) is a registered charity that supports Local Authorities with domestic energy and retrofit programmes. This includes managing and administering the Energy Company Obligation (ECO) Flexible Eligibility Scheme that provides financial assistance for eligible households (defined below) to benefit from energy efficiency and warmth measures.

This form is to certify that the applicant meets the ECO Flexible Eligibility Criteria outlined in the council’s statement of intent (available on the relevant local authority’s website) and that they are eligible for funding to support the installation of energy saving measures to their property.

Note: being eligible is not a guarantee that measures will be installed. A final decision on whether any individual household can benefit under this strand of ECO will be made by the obligated suppliers.

The form should be signed and dated by the householder ONLY.

Once complete please return to: suppliernetwork@nef.org.uk

If you have any questions, please give us a call on 01908 699992.

Surveyor Name*

Name

Address

Postcode

Phone Number

Measure

Tenure

Route 1

SAP bands D-G (owner occupier) or SAP bands E-G (private tenants) households with agross annual income less than £31,000. Gross incomes must be based on all people living in thehome aged 18 or over.

Household Income Declaration (to be completed by people, aged 18 or over, living in the home with gross incomes)

	Name of Resident	Income Source e.g., Wages, State Pension, Private Pension, Carers Allowance etc.	Amount received and how often e.g., monthly, 4 weekly, annually.
Household 1
Household 2
Household 3
Household 4

Route 2: SAP bands E-G households that meet a combination of two of the following proxies:

Homes in Lower-layer Super Output Area 1-3 (LSOA)Householders receiving a Council Tax reduction (reduction based on low income only, excludes single person reduction).Householders vulnerable to living in a cold home as identified in the National Institute for Health and Care Excellence (NICE) Guidance. Only one from the list can be used, excludes the proxy ‘low income’A householder receiving free school meals due to low-incomeA householder supported by a LA run scheme, that has been named anddescribed by the LA as supporting low income and vulnerable households forthe purposes of NICE Guideline. (Details of which can be found within thepublished LA Statement of Intent).A household referred to the LA for support by their energy supplier orCitizen's Advice or Citizen’s Advice Scotland, because they have beenidentified as struggling to pay their electricity and gas bills.

Condition Applied (If Any)

CancerAn adult aged 60 or overA child under the age of 5A pregnant householderChronic health conditions (incl. Cardiovascular, Neurological or neurobiological, Musculoskeletal,Blood conditions or terminal illnesses)Moderate to severe mental illness

Respiratory condition (incl. COPD, asthma) (Please Specify)

Moderate to severe learning or physical disabilities (Please Specify)

Note: proxies 1 and 3 cannot be used together.

Route 3

SAP bands D-G (owner occupier) or SAP bands E-G (private tenants) householdsthat have been identified via NHS Referrals as low- income and vulnerable, with an occupantwhose health conditions may be impacted further by living in a cold home. These healthconditions may be cardiovascular, respiratory, immunosuppressed, or limited mobility related.

Route 4

SAP band D-G (owner occupier) or SAP bands E-G (private tenants) households that arereferred under Route 4: Bespoke Targeting

Suppliers and LAs can apply to NEF where they have identified a low income and vulnerable household, who are not already eligible under the exiting routes.

Note: The National Energy Foundation requires you to provide supporting evidence to confirm your eligibility which will be collected by the installer when they survey your property (please see ECO4 Delivery Guidance on Ofgem’s website for full list of eligible evidence). A number of applications will also be audited. It is therefore imperative that you provide accurate information. Failure to do so may result in you having to refund the costs of any measures which are installed in your property or the costs of any services which you receive.

Data Consent Statement: The National Energy Foundation requires your consent to pass on your details to your local authority and any other known project partners/referral agencies. Your data will be held securely and will not be given to anyone else without your consent.

You have the right to request a copy of the information that we hold about you. If you would like a copy of some or all of your personal information, you can email or write to us to request this. We want to make sure your personal information is accurate and up to date. Please therefore ask us to correct or remove any information you think is inaccurate.

If you change your mind before any installation is completed, you can withdraw your consent to data sharing. Please note that once you have a measure installed you will be unable to withdraw your consent to your data being shared under the scheme for up to seven years due to statutory obligations.

Your data will be kept by the National Energy Foundation and the partners above for the duration of the project and evaluation or as long as installation warranty guidelines and statutory obligations apply. It will then be securely destroyed.

By signing this form, you are confirming that you are full time resident of the address stated, you agree to our data consent statement and that at the time of completing this form the information you have provided is accurate.

Signature

Date

Flexible Eligibility Funding: Self Certification Form

Applicant Information

Eligibility

Note: proxies 1 and 3 cannot be used together.

Suppliers and LAs can apply to NEF where they have identified a low income and vulnerable household, who are not already eligible under the exiting routes.