Clean Energy Program – Stage 1 Application Form |

Clean Energy Program – Stage 1 Application Form

"*" indicates required fields

1. Eligibility Information

2. What happens after you have filled out this form?

3. Applicant details

Your Name*

First Last

Email*

Phone*

Address 1*

Where Clean Energy Program is to be implemented

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Lot Number*

DP Number*

Number of Habitable Buildings*

Postal Address: Is it the same as address 1?*

Yes

Postal Address*

Please input postal address if different to Address 1

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Do you currently operate or intend to operate a business from Address 1?*

Yes

Are you currently renting this property?*

Yes

Is the building subject to the application constructed (or in the final stages of construction) and in regular use:*

Yes

If the building is still being constructed, please describe the current state of construction and when you expect to move in:

4. Property Type

Please provide details of the residence that the Energy Efficiency Package will be performed on:

Number of bedrooms*

Please enter a number from 0 to 10.

Number of storeys*

Please enter a number from 1 to 2.

Number of bathrooms*

Please enter a number from 0 to 10.

Type of roof construction*

Type of building construction*

Please fill in your type of roof construction here*

Please fill in your type of building construction here*

5. Supporting Documentation Checklist & Information

Please upload at least one copy of utility bills for the last 12 months, such as water, gas, or electricity bills.*

You can upload up to 3 files. Supported file formats are images (.jpg, .jpeg, .png) and PDF documents (.pdf). The size of each file should not exceed 20 MB.

Drop files here or

Accepted file types: jpeg, jpg, png, pdf, Max. file size: 20 MB, Max. files: 3.

I, the applicant, confirm:*

Please confirm the following items are accurate and/or have been provided as part of this application. And please ensure that all options are checked; otherwise, the submit button will not appear.

That I meet the Eligibility Criteria described in Section 1 of this form;

That the residence described in ‘Address 1 ’ (part 1 – Applicant Details) has not previously received Energy Efficiency Package, or Stage 2 assistance under the GRWF CLEP;

The copy of electricity, water or gas bills for the last 12 months is included;

6. Communication preference

Our preference is to communicate via email, and it may be necessary for you to print and sign documents to return them to us. If you require documents to be sent by post instead of email, then please tick "Yes" box:*

Yes

7. Authorisation

Please note that the submitted information will be shared with the CLEP Energy Efficiency Expert and Energy Committee to assess your application. All personal information will be stored securely to ensure confidentiality.

Results or successful elements of the Clean Energy Program and the Community Enhancement Program overall may be made public – such as how many homes have participated in the program.

In any publication the names of participants will be withheld unless we obtain your prior written approval.

Please indicate your acknowledgement of the above, and confirmation of the information provided in your application by signing the panel below

Signature*

Date*

Name of person completing the application:*

First Last

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Phone

This field is for validation purposes and should be left unchanged.