Mandatory fields are marked with a * Details of the person making this application Name: * Daytime phone number: * Evening phone number: Mobile phone number: Email Address: Assisted Voucher Code:Click here for guidance notes ) Are you the owner of the property * : Do you rent the property? If you are not the owner, and do not rent the property, please state your title and whether you are the are the builder, developer, agent or other representative. Also provide us with the name of your organisation if relevant: Property where works are to be carried out House number or name: * Address: * City: * Post Code: * Correspondence details (if different to above) Name: House number or name: Address: City: Post Code: If this is a different person to the main applicant, then please state your relationship to them: Property details Is the property * : If the property is a flat or maisonette please say which floor it is on: Is the property a residential household? * : * Note: This form is not suitable for non-residential properties. Please call us on 0870 300 7677 for an application formIs the property a listed building? * How old is the property? * * Note: This form is not suitable for brand new properties, as scaled site plans are required. You can download an application pack here or call us on 0870 300 7677 and we will send one to you.Will you be using gas central heating? * Permission You must have permission to install your new gas connection across any private land that you do not own. To install your new gas connection, will we need to lay any pipe on private land which is not in your ownership? * Do you have all the official consents you require? Meter details Please describe where the meter is, or will be fitted.* Click here for guidance notes ) Meter box you have chosenClick here for guidance notes ) * Service pipe Will you dig and restore the trench in your private land yourself?Click here for guidance notes ) * Please tell us the distance (in metres) from the edge of your property to where you need the meter to be fitted. * Site Access and Variations There must be someone on site when we do the work. Will you be at the property during the work? If no, can our contractors make changes (variations) to the work they plan to carry out at the property (and the cost of the work) without your consent? If you will not be onsite during the works, please give us the details of the person you have chosen to act on your behalf. Name: Daytime phone number: Evening phone number: Mobile phone number: Please tell us their role or relationship to you: Other Please say: Does this person have your permission to make changes to the work we plan to carry out at the property (and the price of the work) on your behalf? If no-one is available to agree any variations to our work, our contractors may not be able to continue. We may have to leave your property and set a new date for the work to take place. We may make extra charges for this. Please include any additional information you think may be relevant.
