COMPLETE THIS SIMPLE FORM TO SEE IF YOU QUALIFY TODAY
Answer a few questions to check your boiler grant eligibility.
Do you have radiators?
*
YES
NO
Do you receive a benefit?
*
YES
NO
Do you own your own home?
*
YES
NO
Was your boiler fitted before 2005?
*
YES
NO
How is your house currently heated?
*
Electric Room Heaters
Electric Storage Heaters
Gas Room Heaters
Single Gas Fire
No Heaters
Gas Warm Air System
Electric Warm Air System
Back Boiler Radiators
Oil Boiler Radiators
Solid Fuel Boiler and Radiators
Condensing Gas Boiler & Radiators
Non-condensing Gas Boiler & Radiators
System Gas Boiler & Radiators
Conventional Gas Boiler & Radiators
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+
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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