1. This form will help identify whether you are eligible for a grant to help you pay for gas central heating. It should be completed by the occupier of the property.

  2. Your details
    1. Your address
  3. Are you the Occupier?
  4. Are you the owner or a tenant?
  5. If you are a tenant, please tell us the landlord or the owner's details.
    1. Landlord's/Owner's details
    2. Landlord's/owner's address

  6. Section 1 - Income Threshold and Vulnerability to the cold

  7. Are you, or any member of the housing, receiving any of the following benefits? Please tick all that apply.

  8. Is the Household income (after housing costs) less than £35,000 per annuum?

  9. Do any of the following apply to you or a member of your household? Please tick all that apply.

  10. Section 2 - Property Efficiency

  11. Is the EPC rating of the property D or below?

  12. How do you currently heat your property?
  13. If you selected other, please provide details below.

  14. Declaration of Eligibility

  15. I declare that I meet the income/vulnerability criteria in section 1 and the property efficiency criteria in section 2.

    The Council will use your information to verify eligibility for the scheme. If you qualify, your name, address and contact details will be passed onto SSE who will organise a technical survey and if feasible, the installation

    For more information about how we handle your data, please see https://www.southhams.gov.uk/Privacy or https://www.westdevon.gov.uk/Privacy

  16. By clicking submit, you consent to us providing the personal data detailed in this form to SSE Ltd.

  17. I have read the declaration and consent to my personal data as detailed in this form being shared with SSE Ltd.