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Welcome

Poll

How many light bulbs in your house are energy efficient?:

None

One or two

Quite a few

Most

Nearly all

Free Insulation Grant Application form

Please enter your details below, checking carefully for errors or missing items. If you need help with filling out the form please call us on 0844 415 52 52, alternatively you can contact us online.

Note that fields marked with a red asterisk * are mandatory.

Personal Details

First Name: *

Surname: *

Date of Birth: *

Contact Details

House Number / Name: *

Address Line 1: *

Address Line 2:

Postcode: *

Home Telephone: *

Work Telephone:

Mobile Telephone:

Email Address: *

Please take care when entering your email address.

Preferred Contact Method: *

Home phone

Work phone

Mobile phone

email

Please let us know which telephone number you prefer to be contacted on or if you prefer to receive email contact. You may choose more than one selection.

Preferred Contact Time: *

9am-12pm

12pm-3pm

3pm-5.30pm

Please let us know which time you prefer to be contacted. You may choose more than one selection.

Grant Information

*this grant does not apply to Council owned and housing association properties

Do you own your home?: *

Yes

No

Do you rent from a private landlord?: *

Yes

No

Do you have any children under the age of 16?: *

No

Yes

..if so please enter the youngest childs date of birth:

If you are pregnant and with maternity certificate MAT B1 please tick the box below:

Yes (MAT B1)

Are you in receipt of any of the following benefits?: *

None

Child Tax Credit with an income of less than 15,460 pounds

Council Tax Benefit

Housing Benefit

Income Support

Pension Credit

Job Seekers Allowance (Income Based)

Working Tax Credit with income of less than 15,460 pounds and which must include a disability element

Disability Living Allowance

Housing Benefit + Disability Premium

Income Support + Disability Premium

Council Tax Benefit + Disability Premium

War Disablement Pension (+ Constant Attendance Allowance or Mobility Supplement)

Attendance Allowance

This field is mandatory. Please tick all that apply, if you are not in receipt of any benefits please choose 'none'

Last but not least

Where did you hear about us?: *

GB Energy is the trading title for Great British Energy Ltd. Reg No: 5346623 GB VAT Registration No. 872092027