Eligibility Form First Name Last Name Email Phone no. Address Postal Code Are you a home owner? Yes No Are you receiving any benefits? Yes No Is anyone in your household in receipt of means tested benefits such as: Universal Credit Working Tax Credit Child Tax Credit Income Support Job Seeker's Allowance Income Based Employment & Support Allowance Housing Benefit Pension Credit Child Benefit Is your home supplied with: Gas Electricity LPG How old is your boiler? Over 10 Years Over 15 Years Over 20 Years I Don't Have a Boiler Send
