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Are you a homeowner?*

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If no then we will require landlord permission, please enter landlord/agent details: name, telephone

Type of Rental*

Type of Rental

Landlord Name*

Enter your landlords name

Landlord Number*

Enter your landlords contact number

Landlord Address*

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Landlord Email*

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Rented Company Name*

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Rented Company Number*

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Are you or anyone in your household in receipt of any of the following?*

You DO NOT have to be on benefits to qualify, please select the following that apply to anyone living in the household

Type of Claimant?*

Type of Claimant?

How many children in household?*

How many children in household?

Is your income before tax and national insurance equal to?*

Is your income before tax and national insurance equal to?

*3.137 Where Child Benefit is used to evidence HTHG eligibility, suppliers should collect evidence of the occupier’s bank statement, payslips or P45 showing both that Child Benefit payments can be provided and that the occupier’s income is within the ECO4 Child Benefit thresholds, see below in Table 3.

Child Benefit income thresholds Table 3 provides the figures for the ECO4 Child Benefit income thresholds.

Source: "ECO 4 Delivery Guidance v01 publication" https://www.ofgem.gov.uk/publications/draft-energy-company-obligation-eco4-guidance-delivery-v01

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