Who can complete this form
Complete this form if you are of pensionable age and need support with energy bills.
About this form
We can help with:
- checking if you’re eligible for Pension Credit and Winter Fuel Allowance payments, and supporting you in making an application
- energy costs if you’re struggling to keep warm or afford your bills
- costs of food and other essentials
- making referrals to LEAP, Energyworks and money advice services
- liaising with utility companies about your debt
- providing free Carbon Monoxide alarms and arranging home safety visits
- checking eligibility to join the priority services registers (energy and water)
- energy advice on keeping warm in an affordable way
To apply for help for yourself, you need to:
- tell us your age or date of birth
- give us your contact details, including your:
- email and phone number
- address
To apply for help for someone else, you need to:
- tell us who you are trying to get help for
- tell us their age or date of birth
- give us contact details for the person you want to get help for, including their:
- email and phone number
- address
- confirm the person you are referring, has given you consent to apply on their behalf
If you need help to fill in this form, you can: