Off grid heating fuel support scheme – Application form

1Your Details 2Enquiry Details

Your Details

Address

Enquiry Details

Council Tax Account Reference

I wish for the £200 payment to be made to the following bank account: N.B. The bank account you provide must be in the name of the person(s) identifiable as liable to pay the council tax bill. If you do not have a bank account, please contact us directly to discuss alternative arrangements.

Bank Details

Name on Bank Account

Bank Sort Code

Bank Account Number

Building society roll number (if you have one)

Please upload a copy of a bank statement dated within the last 6 months, AND a heating oil OR LPG bill dated within the last 12 months

Attachments

Please tick to confirm the following:

I confirm that I am responsible for the Council Tax Bill and I use heating oil or LPG as my main source of heating I confirm that I have included a heating oil or LPG bill (or copy) dated within the last 12 months alongside this application I confirm that I have supplied a copy of a bank statement dated within the last 6 months alongside this application I have read the Privacy Notice