Check Your Eligibility by Filling our Completely Free Form

Please complete this form below as accurately as possible. This helps us assess whether you may have a valid claim
relating to incorrectly fitting fitted ECO4 or GBIS energy-efficiency works.

📋 Section 1 – Personal Details

First Name *

Last Name *

Date of Birth *

Contact Telephone Number *

Email Address *

Best Time to Contact You *

🏠 Section 2 – Property Details

Address Where ECO4 Work Was Carried Out *

Town / City *

County *

Postcode *

Is this property: *

Is the property still owned by you? *
YesNo

🔧 Section 3 – ECO4 / GBIS Installation Details

Approximate Date Work Was Installed *

Funding Scheme *

Which energy-efficiency measures were installed? (Tick all that apply) *
Internal Solid Wall Insulation (IWI)External Solid Wall Insulation (EWI)Cavity Wall InsulationLoft InsulationUnderfloor InsulationHeat PumpSolar PanelsBoiler / Heating ControlsOther

If Other, please specify:

👷 Section 4 – Installer & Guarantee Information

Name of Installer / Company

Is the installer still trading? *

Did the installer provide any guarantees or warranties? *
YesNoNot sure

Guarantee Provider

Certificate Number

⚠️ Section 5 – Problems Experienced

Have you experienced any issues since the work was completed? *
YesNo

If yes, please tick any that apply:
Damp or mouldCondensation problemsStructural cracking or damagePoor workmanship / unfinished workIncreased energy billsCold spots or ineffective insulationVentilation issuesProperty value affectedOther issues

Please briefly describe the problems you've experienced:

🔨 Section 6 – Remedial Action

Have you contacted the installer? *
YesNo

Surveys carried out? *
YesNo

If contacted, what was the outcome?

✅ Section 7 – Declaration & Consent

Please confirm the following: *

I confirm the information provided is accurate to the best of my knowledge
I consent to my details being reviewed for the purpose of assessing a potential ECO4 compensation claim
I understand this is a free eligibility check and does not create any obligation

Signature (typed name): *

Date: *

Check Your Eligibility by Filling our Completely Free Form

📋 Section 1 – Personal Details

🏠 Section 2 – Property Details

🔧 Section 3 – ECO4 / GBIS Installation Details

👷 Section 4 – Installer & Guarantee Information

⚠️ Section 5 – Problems Experienced

🔨 Section 6 – Remedial Action

✅ Section 7 – Declaration & Consent

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