Full Name Email Phone Address Line 1 City Post Code What is your current tenure? HomeownerPrivately RentingSocial Housing What is your EPC Rating? ABCDEFGUnsure Is there Gas connection to the property? YesNo Was your gas meter installed before 31st March 2022? YesNo Current main heating system? Gas Central Heating LPG Central Heating Electric Heating Oil Central Heating Renewable Heating Infrared Central Heating Secondary heating system Electric Panel or Oil Room Heater Solid Fuel Fires Storage Heaters None What is your boiler type? Combi Boiler Condenser Boiler 1960 to 1980 Black Boiler What is the make and model of your boiler Do you have a separate hot water cylinder? YesNo Does your property have a loft or a room in the roof? YesNo Is the loft insulated? YesNo What is your property type? DetachedSemi-DetachedMid TerraceMaisonetteBungalowFlat What is the wall type? Solid Brick WallCavity WallStone WallUnsure / Other Do you have any wall insulation? Filled CavityExternal Wall InsulationInternal Wall InsulationNo Insulation / Unsure What is your current heating system? Electrical Underfloor HeatingElectric Storage HeatersGas Central Heating BoilerGas Fire / Back BoilerSolid Fossil Fuel Fire / OpenBottled LPG HeatingWood/Biomass HeatingOil HeatersNo Heating Benefits Select any benefits you are receiving Child Tax Credits (CTC) Child Benefits Jobseekers Allowance Employment & Support Allowance Income Support (IS) Pension Credit Guarantee Universal Credit (UC) Warm Home Discount Scheme Rebate Working Tax Credit (WTC) Housing Benefit Pension Credit Saving Send
