COMPLETE THIS SIMPLE FORM TO SEE IF YOU QUALIFY TODAY
Answer a few questions to check your eligibility for a boiler grant. We’ll only contact you if you qualify.
Do you have radiators?
*
YES
NO
Do you receive a benefit?
*
YES
NO
Do you own your own home?
*
YES
NO
Does your boiler have a tank connected?
*
YES
NO
Don't Know
How is your house currently heated?
*
No central heating
Old boiler with tank
Combi boiler
Condensing boiler
Other
If ‘Other’, please describe your heating system.
What is your house type?
*
Terraced
Semi-detached
Detached
Bungalow
Flat
Other
How many bedrooms does your house have?
*
1
2
3
4
5
6+
House number or name:
*
Postcode
*
Name:
*
First Name
Last Name
E-mail
*
Phone Number
*
Street Name
*
What type of benefit do you receive?
*
Income Based Jobseekers Allowance
Income related Employment & Support Allowance
Income Support
Pension Credit Guarantee
Pension Credit Savings
None
Housing Benefit
Working Tax Credit
Child Tax Credit
Universal Credit
Earning based child benefit
If you do not claim benefits, do any of these apply?
*
1) Total household earnings under 31K gross
2) Health condition including mobility, respiratory, cardiovascular, immunosuppressed
3) None of the above
Is your house rented or owned?
*
Owned
Private Rented
Council Rented
Social Housing Rented
Any other comments:
(Optional)
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