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Eco4 Scheme
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Privacy Policy
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Name
*
Street Address
*
Apartment, suite, etc
City
State/Province
ZIP / Postal Code
Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Australia
Aruba
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cabo Verde
Cayman Islands
Central African Republic
Chad
Chile
China, People’s Republic of
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Côte d’Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
France, Metropolitan
French Guiana
French Polynesia
French South Territories
Gabon
Gambia
Georgia
Germany
Guernsey
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island And Mcdonald Island
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Johnston Island
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People’s Republic of
Korea, Republic of
Kosovo
Kuwait
Kyrgyzstan
Lao People’s Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
North Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montserrat
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Reunion Island
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
Saint Helena
Saint Pierre & Miquelon
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and South Sandwich
Spain
Sri Lanka
Stateless Persons
Sudan
Sudan, South
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syria
Taiwan, Republic of China
Tajikistan
Tanzania
Thailand
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks And Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
US Minor Outlying Islands
United States of America (USA)
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis And Futuna Islands
Western Sahara
Yemen Arab Rep.
Yemen Democratic
Zambia
Zimbabwe
Date of Birth
*
Date of Birth
Email Address
*
Phone
*
Confirm Occupancy
*
Home Owner
Private Tenant
Landlord
Council Tenant
What is your relationship to the property you are applying for?
Household Income
Less than £31k
More than £31k
Not Sure
House Hold Health
No Health Issues
Health Conditions
GP Sign Off
List of Health Conditions
Household Benefits
*
No Benefits Present
JSA
Income Support
Pension Credit Guarantee Credit
Working Tax Credit
Child Tax Credit
Universal Credit
Housing Benefit
Pension Credit Savings Credit
Other Benefits
Please select all benefits that are currently recieved within this household
Other Benefits
What is the properties EPC rating
Unknown
A
B
C
D
E
F
G
No EPC
What is your Property Type
Detached House
Semi Detached House
Terraced House
Detached Bungalow
Semi Detached Bungalow
Chalet or Park Home
Flat
What year was your property built
Pre 1900
1901-1940
1941-1960
1961-1979
1980-1998
1999 +
Not Sure / Don’t know
Are your walls insulated?
Insulated
Not Insulated
Unknown
Confirm your Boiler Details
*
Is the Property Listed?
No
Grade 1
Grade 2
Conservation Area
Unknown
Confirm Prior Works to the property
*
Solar Panels
Loft/Roof Insulation (Any)
Wall Insulation (Any)
Floor Insulation (Any)
New Boiler / Central Heating (Any)
No Works in last 8 years
Thermal
You must select one or some of the options (if fitted to the property in the last 8 years)
Has this property had ECO Funding before?
Yes
No
Unknown
Approximate Date of Funding
Confirm the heating type fitted to your property
Solid Fuel (to Radiators)
Solid Fuel (no Radiators)
Electric Boiler (to Radiator)
Electric Panel Heaters
Electric Storage Heaters (Old)
Electric Storage Heaters (New)
LPG (Bulk Tank)
LPG (Bottles)
No Heating
Oil Boiler (unknown)
Oil Boiler (non condensing)
Oil Boiler (condensing)
Mains Gas (boiler unknown)
Mains Gas (room heaters)
Mains Gas non condensing
Renewable heating (biomass, air source etc)
Mains Gas Condensing
Additional Property Information
Solid Ground Floor
Floor Boards
Basement
Loft Insulation (More than 100mm)
Loft Insulation (Less than 100mm)
No Loft Insulation
Water Tank on Boiler?
Please select if you have any of the following
Consent and Submit
*
I agree to my information provided being shared with the Department for Work and Pensions via the Energy Saving Trust to confirm whether I am in receipt of the relevant benefit(s) to be eligible for the ECO4 and GBIS schemes. I authorise freeboilergrants uk to contact me in relation to funded home improvements
Please Tick the 2 tick boxes then add your signature below
Signature
*
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