Applying for yourself

Please read the below information carefully before completing the application form

In order to qualify for a new appliance, you will need to confirm the following:

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• that you receive certain means-tested benefits. Please note you will have to upload a photo of a benefits statement that is less than 18 months old and ensure that it is in the same name as the applicant
   

• that you have an existing appliance to be replaced. Please note that this will be removed and disposed of at the same time that your new appliance is professionally installed.

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If the above applies to you, please complete the application form below.