Carbon Leads
*
Contact Full Name
Company name if a business
Email Address
Full Name of person on benefits
DOB of Person on benefits
*
Phone
*
First line of Address
*
City/Town
*
Post Code
Property Ownership
Social Tenant
Private Tenant
Owner/Occupier
Heating
Gas boiler more than 3 years old
Gas Boiler condensing
Gas Boiler non-CondensingBoiler with BackBolierOil
Solid Fuel
Electric Storage Radiators
Other
Insulation
None
Cavity Wall Insulation
External Wall Insulation
Floor Insulation
Roof Insulation
Any Previous Grants
Yes
No
If Y - What Grant and date
EPC Rating
C
D
E
F
G
EPC Date
EPC Expired
What Benefits
1) Income based Jobseekers Allowance (JSA)
2) Income related Employment and Support Allowance (ESA)
3) Income Support (IS)
4) Pension Credit Guarantee Credit (PCGC)
5) Working Tax Credit (WTC)
6) Child Tax Credit (CTC)
7) Universal Credit (UC)
8) Housing Benefit
9) Pension Credit Savings Credit (PCSC)
10) Child Benefit
(within the income caps
see Chapter 5 of the ECO4 Guidance: Delivery)
Other Benefits Not Listed Above
*
Comments and other details
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