Full Name Email Phone Address Line 1 City Post Code What is your current tenure? Homeowner Privately Renting Social Housing What is your EPC Rating? A B C D E F G Unsure Is there Gas connection to the property? Yes No Was your gas meter installed before 31st March 2022? Yes No 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? Yes No Does your property have a loft or a room in the roof? Yes No Is the loft insulated? Yes No What is your property type? Detached Semi-Detached Mid Terrace Maisonette Bungalow Flat What is the wall type? Solid Brick Wall Cavity Wall Stone Wall Unsure / Other Do you have any wall insulation? Filled Cavity External Wall Insulation Internal Wall Insulation No Insulation / Unsure What is your current heating system? Electrical Underfloor Heating Electric Storage Heaters Gas Central Heating Boiler Gas Fire / Back Boiler Solid Fossil Fuel Fire / Open Bottled LPG Heating Wood/Biomass Heating Oil Heaters No 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
