EcoFlex

Flexible Eligibility Form

Tenure type: *

Private tenant
Owner Occupier

Evidence
Please tick all that you are providing for this application

Land Registry entry

Deeds or mortgage statement dated within the last 12 months (If Land Registry entry unavailable)

Relevant OFGEM template (If none of the above are available)

If private rented one of the above PLUS landlord’s permissions forms

Please note: Private rented properties with a D rating DON’T qualify. Properties with no EPC or an EPC rating of A, B or C rated properties DON’T Qualify

EPC Rating

D

E

F

G

TESTING

Qualifying Route

Please select a qualifying route

Route 1

Route 2

Route 3

Route 2

Please select a combination of 2 of the below proxies

Proxy 1 and Proxy 3 cannot be used together

Proxy 1 - Applicant’s address located in LSOA ranked 1 – 3

Proxy 2 - Householders receiving a Council Tax Rebate

Proxy 3 - Householders vulnerable to living in a cold home.

Proxy 4 - A householder receiving free school meals at the property

Proxy 5 - A household referred or supported by a Local Authority (LA) run scheme. The scheme must be one which supports low income and vulnerable households.

Proxy 6 - A household referred to the LA for support by their energy supplier or Citizen’s Advice. This would be because they have been identified as struggling to pay their electricity and gas bills

Route 3

Has the householder received a letter from the NHS Referring them to ECO Flex scheme? *

Yes
No

Route 3 Evidence

An official letter signed by either:

an NHS Trust or NJS Trust Board
an NHS Primary Care provider
a general medical practitioner provider. (GP, Doctor)

This letter needs to confirm someone in the household has one of the health conditions listed below.

cardiovascular condition
respiratory disease
limited mobility
immunosuppression

We’re sorry

Unfortunately, you do not qualify for flexible eligibility.

Evidence Upload

Tenure evidence

Please upload the following tenure evidence.

Land Registry entry

Deeds or mortgage statement dated within the last 12 months (If Land Registry entry unavailable)

Relevant OFGEM template (If none of the above are available)

Landlord’s permissions forms

Route 1 evidence

Please upload the following Route 1 evidence.

Tax returns if within the past three months

Payslips from the last three months

P45 or P60, so long as the households annual income is visible

Bank statements within the last three months proving income payments, including non means tested benefits

Route 2 evidence

Please upload the following Route 2 evidence.

A Screenshot showing the household is in a deprived area. This would be living in an LSOA in the first, second or third decile on the Index of Multiple Deprivation for 2019. Check this here: https://onsdigital.github.io/postcode-lookup. Please note: If the postcode returns no results, you will need to manually zoom into the map.

Proof of council tax reduction. This could be a photo, an email, or PDF with name and address. Or a letter confirming reduction from LA

Signed, referral letter from a Doctor / GP identifying that a person living at the premises Is considered to be vulnerable to the cold and suffers from a health condition as stated in the NICE guidance: NG6, excluding the low-income proxy

Eligibility Checking Service (ECS). Proof of eligibility for free school meals due to low-income. This needs to be from the Department for Education or the school

A signed letter from local coordinator /or local authority that proves the household was eligible for an LA-run scheme.

A signed letter from the energy supplier or Citizen’s Advice, and proof of gas and electricity debt.

Route 3 evidence

Please upload the following Route 3 evidence.

An official letter signed by either an:

NHS Trust, NJS Trust Board
NHS Primary Care provider
A general medical practitioner provider. (GP, Doctor)

This letter needs confirm someone In the household has one of the health conditions listed below:

cardiovascular condition
respiratory disease
limited mobility
immunosuppression

Upload

Please note, the maximum total size you can upload is 12Mb.

Choose a file:

Upload

The total file size of the documents you are trying to upload is too high. Please remove files so that the total is less than 12MB.

Applicants details

Applicants name: *

House name/number:

Postcode:

Address: *
You can enter the house name/number and postcode above to populate this field.

Telephone number:

Email address: *

Is your address the same as the properties address? *

Yes
No

Please enter the properties address

House name/number:

Postcode:

Address: *
You can enter the house name/number and postcode above to populate this field.

Energy supplier details

Company name:

Name of agent/supplier completing form:

Company address: *

Postcode: *

Telephone number: *

Central email address for company: *

Important reminder

The administration charge levied by Torbay Council in providing the declaration necessary for clients to access the ECO Flexible Eligibility Scheme is £200. This charge must be paid by the energy supplier or their agent and may NOT under any circumstances, be passed on to the client receiving assistance via the scheme.

Payment can be made at point of the application or billing will be monthly.

Do you understand and accept the conditions above?

Declaration

If you knowingly make a false statement you may be liable to prosecution.

Please tick to declare that to the best of your knowledge the details provided in this form are accurate

Data protection

Information collected and processed by us complies and is stored in accordance with the UK Data Protection Act 1998. The information you have provided will be used and shared for the purpose for which it's collected. The information will not be shared with third parties, however, in certain circumstances we may need to disclose information to third parties such as the police or the Department for Work and Pension as required by applicable legislation or for the prevention and detection of crime.

We may use the details you have provided to contact you about council service, this may be through email, post or SMS text message.

For further information regarding personal data that Torbay Council may hold on you and how to access it visit www.torbay.gov.uk/sar

Please tick to confirm you accept these conditions

EcoFlex

Flexible Eligibility Form

Qualifying Route

Route 1

Evidence

Route 2

Route 3

Route 3 Evidence

We’re sorry

Measures

Evidence Upload

Route 3 evidence

Upload

Upload

Applicants details

Energy supplier details

Important reminder

Declaration

Data protection