ECO Flex / GBIS Declaration Application

Label
1. Installer*
2. Customer Name*
3. Address of premises requiring measures
  1. Building Number/Name
  2. Street
  3. Town
  4. Post Code
4. Number of adults residing at the property*
5. Telephone*
6. Route used for application*
  
  1
  
  2
  
  3
  
  4
7. Route 1
  1. If using Route 1, please provide the information below;
  2. Tenure
  3. EPC rating before
    Please ensure that the format for the EPC rating is G01 or B83
  4. Date of EPC
    
    Day
    
    Month
    
    Year
  5. Measure to be installed
  6. Value of grant funding requested (£)
  7. Income below £31,000
  8. Evidence of income provided
  9. New EPC rating after measure installed
    Please ensure that the format for the EPC rating is G01 or B83
8. Route 2
  1. If using Route 2, please indicate properties SAP Rating and Proxy's Used;
  2. EPC rating before
    Please ensure that the format for the EPC rating is G01 or B83
  3. Date of EPC
    
    Day
    
    Month
    
    Year
  4. Measured to be installed
  5. Value of grant funding requested (£)
  6. New EPC rating after measure
    Please ensure that the format for the EPC rating is G01 or B83
  7. Proxy
    
    1
    
    2
    
    3
    
    4
    
    5
    
    6
    
    7
  8. Please tick the two appropriate proxies and provide the evidence for both in the fields below. Note: proxies 1 & 3 and proxies 6 & 7 cannot be used in combination with each other.
  9. Proxy Evidence provided
  10. Proxy Evidence provided
9. Route 3
  1. If using Route 3, please provide the SAP rating, measures to be installed, the proposed final SAP Rating and the Medical evidence provided;
  2. EPC rating before
    Please ensure that the format for the EPC rating is G01 or B83
  3. Date of EPC
    
    Day
    
    Month
    
    Year
  4. Measures to be installed
  5. Value of grant funding requested (£)
  6. New EPC rating after measure installed
    Please ensure that the format for the EPC rating is G01 or B83
  7. Medical Condition Evidence Provided
10. Route 4
  1. If using Route 4, please provide the following;
  2. EPC rating before
    Please ensure that the format for the EPC rating is G01 or B83
  3. Date of EPC
    
    Day
    
    Month
    
    Year
  4. Measures to be installed
  5. Value of grant funding requested (£)
  6. New EPC rating after measures installed
    Please ensure that the format for the EPC rating is G01 or B83
  7. Route 4 Application number
12. Depending on what route you are applying through, you will need to provide us with different types of evidence to support the application. Please attach all relevant related pieces of evidence.
1. Attachment 1
2. Attachment 2
3. Attachment 3
4. Attachment 4
5. Attachment 5
6. Attachment 6
7. Attachment 7
8. Attachment 8
9. Attachment 9
10. Attachment 10
2. All evidence provided for proxy's must be retained for auditing purposes.
3. All evidence of measures installed must be retained for audit purposes.
4. The scheme will be reviewed annually or at any point there is a significant change to the scheme or the funding available.
5. Contractor,
  
  By hitting submit you confirm that the answers provided are to the best of your knowledge, at the time the questionnaire was completed, and that you have the householder's permission to carry out this work.
  
  Please provide your details below in order for us to contact you for any further information and to send you the LA Declaration.
  
  Further information about how the council manages personal information can be found within our privacy policy
6. Your Name*
7. Your Contact Number*
8. Your Email*
REVIEW
1. Officer's name
2. Has this request been
  
  Accepted
  
  Declined
  
  Further information required
3. Reason for declined
4. What information is missing
  You can enter up to 255 characters

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ECO Flex / GBIS Declaration Application