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* 1. Contact Details

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* 2. Please tell us about your household - Number of adults and children with their ages.

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* 3. I can provide photo ID and proof of address - this is essential and no voucher can be issued without this proof. 

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* 4. I can provide photographic proof of a prepayment meter. Please note that British Gas meters are not included in this scheme.

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* 5. National Insurance Number of lead adult

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* 6. Employment Status ( this does not affect your application) of lead adult

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* 7. I confirm that I can receive email vouchers

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* 8. If you do not have an email address we can send your voucher to your Work Coach or  Case Worker. Please provide contact details below

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* 9. I can confirm that the pandemic has had a financial impact.

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* 10. I can confirm that I have not received Energy Redress Vouchers from other organisations in the last 3 months. . 

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* 11. Do you have any other comments, questions, or concerns?

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* 12. I agree to complete a feedback form 

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