Warm Front Grants with Warmer Heating LTD - Apply for a Warm Front Grant

Grant Applicants Details

Title:*
First name:*
Surname:*
Phone no:*
2nd Phone num:
Best contact time:
Email address:
DOB:*

Grant applicant's address:

House/Flat number/name:*
Address 1:*
Address 2:
Town / City:*
Post Code:*

If the person listed above is a tenant at the address, please provide the landlords details below

Landlords Name
Address 1:*
Address 2:
Town / City:*
Post Code:*

Please only answer this section if you are over 60

Income Support
Council Tax Benefit (not single occupancy discount)
Housing Benefit
Job Seekers Allowance (income-based)
Pension Credit

Please only answer this section if you a pregnant householder with maternity certificate MAT-B1 or you have children under 16

Income Support
Council Tax Benefit (not single occupancy discount)
Housing Benefit
Job Seekers Allowance (income-based)
Pension Credit

Are you a householder in receipt of one or more of the following benefits

Working Tax Credit (with an income of less than £15,460,
which must include a disability element)

Disability Living Allowance (not child DLA)
Child Tax Credit (with an income of less than £15,460)
Job Seekers Allowance (income-based)
Pension Credit
DOB of youngest child:*
Housing Benefit (which must include a disability premium)
Income Support (which must include a disability premium)
Council Tax Benefit (which must include a disability premium)
Industrial Injuries Disablement Benefit (which must include a mobility
supplement or Constant Attendance Allowance)

Attendance Allowance
Which type of property do you live in ?*
Is your house attached, detached, or semi detached ?*
How many bedrooms does your property have ?*
What type of heating do you have ?*
Approximately what year was your house built? *

Final questions

Do you have cavity wall insulation ?*
Do you have full loft insulation ?*
Do you have heating ?*