APPLICATION FORM

Name *

E-Mail *

Tel No *

Address *

Date of Birth *

NI Number *

UTR Number *

Trading Name (if applicable)

VAT Number (if applicable)

Registered Company Number (if applicable)

Do you hold Public Liability Insurance of £2m or more * YesNo

If ‘Yes’’, Public Liability Insurance Policy Number

Gas Safe Qualified? * YesNo

If ‘Yes’’, Gas Safe Registered Number

Oftec Qualified? * YesNo

If ‘Yes’’, Oftec Registered Number

Any other qualifications?

Basic boiler wiring

Powerflushing with a water sample taken when complete

Making good around flues where required

Any other comments