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Green Deal Provider Authorisation - Application for the ‘non-domestic’ Green Deal Provider status Applicants should note: The information you supply in this application will be used to determine eligibility to become a Green Deal Provider with ‘non-domestic’ status. Green Deal Providers, including those with ‘non-domestic’ status, may register with the Crown Commercial Service (CCS), the ECO Brokerage platform administrators, for access to the auctions and to trade. For further information on ECO Brokerage, including the rules, other eligibility requirements and evidence required by CCS to gain access, please visit https://www.gov.uk/energy-companies-obligation-brokerage . As a ‘non-domestic’ Green Deal Provider you will not be able to write Green Deal plans that require consumer credit permissions. If you wish to write Green Deal plans you must contact the Financial Conduct Authority (FCA) to obtain the requisite consumer credit permissions. You will also need to apply on separate forms to the Green Deal Oversight and Registration Body to operate as a ‘domestic’ Green Deal Provider: http://gdorb.decc.gov.uk/providers/become-a-provider . For further information please visit http://www.fca.org.uk or call the FCA contact centre on: 0845 606 9966. Before submitting this application please ensure copies of the following documentation are provided: Your Organisation’s Complaints Handling Procedure Your Organisation’s Queries Handling Procedure Your Organisation’s Data Protection and Information Security Policy/Procedure 1 Green Deal Provider Authorisation - Application for ‘non-domestic’ Provider Status

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Green Deal Provider Authorisation - Application for the ‘non-domestic’ Green Deal Provider status

Applicants should note:

The information you supply in this application will be used to determine eligibility to become a Green Deal

Provider with ‘non-domestic’ status. Green Deal Providers, including those with ‘non-domestic’ status, may

register with the Crown Commercial Service (CCS), the ECO Brokerage platform administrators, for access to the

auctions and to trade. For further information on ECO Brokerage, including the rules, other eligibility

requirements and evidence required by CCS to gain access, please visit https://www.gov.uk/energy-companies-

obligation-brokerage.

As a ‘non-domestic’ Green Deal Provider you will not be able to write Green Deal plans that require consumer

credit permissions. If you wish to write Green Deal plans you must contact the Financial Conduct Authority (FCA)

to obtain the requisite consumer credit permissions. You will also need to apply on separate forms to the Green

Deal Oversight and Registration Body to operate as a ‘domestic’ Green Deal Provider:

http://gdorb.decc.gov.uk/providers/become-a-provider. For further information please visit http://www.fca.org.uk

or call the FCA contact centre on: 0845 606 9966.

Before submitting this application please ensure copies of the following documentation are provided:

Your Organisation’s Complaints Handling Procedure

Your Organisation’s Queries Handling Procedure

Your Organisation’s Data Protection and Information Security Policy/Procedure

Your Organisation’s Health and Safety Policy/Procedure

Note: The Green Deal Oversight and Registration Body (GD ORB) will not be able to process application forms

that do not have the above documents attached.

Prior to completing this application, Applicants are advised to refer to the following, which should be read in

conjunction with Part 1, Chapter 1 of the Energy Act 2011, the Green Deal Framework Regulations (Disclosure,

Acknowledgement, Redress, etc.) Regulations 2012 and the Green Deal Code of Practice (GD CoP):

Guidance for Applicants

Becoming an Active Green Deal Provider Guidance

Please visit: http://gdorb.decc.gov.uk/providers/green-deal-provider-guidance for details.

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This application should be completed by:

(a) a Company Director, where the applicant organisation is a registered company, or

(b) a person with the appropriate authority, for all other kinds of applicant organisations.

The GD ORB may contact applicants for further information to supplement their application. Completed

applications must be submitted electronically via email to: [email protected]. Electronic

signatures are acceptable.

Any queries regarding this application should be directed to the GD ORB helpdesk via

[email protected]

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1. APPLICATION AND ADMINISTRATION DETAILS

1.1 CORPORATE INFORMATION

Please provide current details in the table below.

Applicant Organisation Name (Registered Company Name if applicable)

Click here to enter text.

Company Registration Number (if applicable)

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Nature of Applicant Organisation’s Legal Structure (e.g. Company Limited Liability Partnership)

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Registered Address line 1: Click here to enter text.

Registered Address line 2: Click here to enter text.

Registered Address line 3: Click here to enter text.

City / Town: Click here to enter text.

Postcode: Click here to enter text.

Country (England / Scotland / Wales): Click here to enter text.

Principal Trading Address line 1 (If different from registered address):

Click here to enter text.

Principal Trading Address line 2: Click here to enter text.

Principal Trading Address line 3: Click here to enter text.

City / Town: Click here to enter text.

Postcode: Click here to enter text.

Country (England / Scotland / Wales): Click here to enter text.

Telephone Number: Click here to enter text.

Email: Click here to enter text.

Website: Click here to enter text.

Parent Registered Name and Number (If applicable):

Click here to enter text.

Parent Entity Trading Name (If applicable and different to above):

Click here to enter text.

Name(s) of all the Applicant Organisation’s Click here to enter text.

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Registered Company Directors:

Operational Contact for Green Deal Provider Authorisation Process (Name, Contact number and Email) :

Click here to enter text.

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1.2 APPLICANT DETAILS

Applicant Name: Click here to enter text.

Applicant Reference Number: Click here to enter text.

Point of Contact for Green Deal Provider Authorisation Process:

Note: Details of the application will only be disclosed to the nominated point of contact.

Name: Click here to enter text.

Contact number: Click here to enter text.

Email: Click here to enter text.

Please provide a Profile for the Applicant Organisation (MAX 300 WORDS). Please include:

the applicant organisation’s name;

Director/s relevant skills, history and

experience;

which sector(s) the applicant

organisation currently operates in;

whether the applicant organisation has

previously been involved in the CERT

or CESP schemes;

if the applicant organisation is an

authorised GD Installer/Assessor

whether it plans to install all measures

itself; and

which town or city the applicant

organisation principally operates in.

Click here to enter text.

1.3 OPERATIONAL REGIONS

Please indicate your organisations planned geographical coverage in which you intend to become operational in,

if authorised.

National or:

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England

Wales

Scotland

2. PREVIOUS APPLICATIONS

2.1 PREVIOUS APPLICATIONS

Has your business, any director, manager or shareholder applied for Green Deal Provider authorisation

previously? Please tick as appropriate:

No

Yes (please provide details below)

NAME OF ORGANISATION / INDIVIDUAL THAT PREVIOUSLY APPLIED

DATE(S) OF PREVIOUS APPLICATION(S)

PREVIOUS APPLICATION NUMBER(S) (GDPA)

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3. ASSOCIATED APPLICANTS

Is your organisation commercially connected in any way to any other authorised Green Deal Provider(s), other

applicant(s) or to organisations whose applications for authorisation as a Green Deal Provider were refused?

Please tick as appropriate:

Yes No

If yes, please provide the organisation name(s), GDPA reference number(s) and brief details of commercial

relationship (200 word max):

Click here to enter text.

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4. IS THE APPLICANT ORGANISATION ACCREDITED OR AUTHORISED UNDER ANY OF THE FOLLOWING SCHEMES?

Please tick all that apply and provide relevant membership numbers.

SCHEME MEMBERSHIP NUMBER

British Standards Institution (BSI) Click here to enter text.

The Microgeneration Certification Scheme (MCS) Click here to enter text.

Trustmark Click here to enter text.

ISO Accreditation (please list all that apply) Click here to enter text.

Competent Persons Scheme Click here to enter text.

Construction Licensing Executive (CLE Scotland) Click here to enter text.

Gas Safe Click here to enter text.

Fenestration Self-Assessment Scheme (FENSA) Click here to enter text.

Solid Wall Insulation Guarantee Agency (SWIGA) Click here to enter text.

The Contractor’s Health and Safety Assessment Scheme

(CHAS)

Click here to enter text.

Cavity Wall Insulation Self Certification Scheme Click here to enter text.

NICEIC Click here to enter text.

Renewable Energy Consumer Code (RECC) Click here to enter text.

Other (Please list all relevant schemes and corresponding membership numbers)

Click here to enter text.

5. IS THE APPLICANT ORGANISATION A MEMBER OF ANY OF THE FOLLOWING PROFESSIONAL OR TRADE BODIES?

Please tick all that apply and provide relevant membership number.

PROFESSIONAL/TRADE BODY MEMBERSHIP NUMBER

Royal Institution of Chartered Surveyors Click here to enter text.

Royal Institute of British Architects Click here to enter text.

Building and Engineering Services Association (formally HVCA)

Click here to enter text.

National Insulation Association Click here to enter text.

Electrical Contractors Association Click here to enter text.

Energy Institute Click here to enter text.

Other (Please list all relevant bodies and corresponding

membership numbers)

Click here to enter text.

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6. DO ANY SENIOR MEMBERS OF STAFF, DIRECTORS OR THE ORGANISATION HAVE UNSPENT CRIMINICAL CONVICTION(S) OR CIVIL COURT JUDGEMENT(S) AGAINST THEM IN THE LAST FIVE YEARS?

Yes No

Please note: The GD ORB will conduct a credit check as part of the verification process.

If yes, please provide the following information:

YEAR ISSUE OUTCOME BRIEF SUMMARY OF PREVENTATIVE MEASURE

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7. HAVE ANY DIRECTORS FILED FOR BANKRUPTCY OR INSOLVENCY WITHIN THE PAST FIVE YEARS?

Yes No Ongoing

If yes, please provide the following information:

BUSINESS TRADING NAME

COMPANY HOUSE NO.

BANKRUPTCY/INSOLVENCY? PLEASE INCLUDE INFORMATION ON CUSTOMER IMPACT E.G DETAILS OF ANY MONEY LEFT OWING.

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8. CREDIT PROVISION

8.1 HAS THE APPLICANT ORGANISATION CARRIED OUT ANY TYPES OF

BUSINESS THAT ARE REGULATED UNDER THE CONSUMER CREDIT ACT

1974 IN THE PAST?

Yes No Ongoing

If yes, what types of regulated business has your organisation carried out?

Click here to enter text.

8.2 HAS YOUR ORGANISATION EVER BEEN INVESTIGATED BY THE

FINANCIAL CONDUCT AUTHORITY (FCA) OR OFFICE OF FAIR TRADING

IN RELATION TO THE PROVISION OF CREDIT?

Yes No Ongoing

If yes, was your organisation found to be in breach of their standards?

Yes No Ongoing

If yes, please provide the following information:

DATES OF INVESTIGATION BREACH OUTCOME

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8.3 HAS THE APPLICANT ORGANISATION EVER BEEN SUBJECT TO

SANCTIONS IN RELATION TO THE PROVISION OF CREDIT?

Yes No Ongoing

If yes, please provide the following information:

DATES OF INVESTIGATION SANCTION OUTCOME

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8.4 HAS THE APPLICANT ORGANISATION EVER BEEN INVESTIGATED FOR

BREACHING ANY OTHER CODES?

Yes No Ongoing

If yes, please provide the following information:

DATES OF INVESTIGATION CODE BREACH OUTCOME

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text.

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9. MARKETING AND SALES

9.1 HAS THE APPLICANT ORGANISATION EVER BEEN INVESTIGATED FOR A BREACH OF CONSUMER PROTECTION LEGISLATION IN RELATION TO MARKETING AND SELLING PROCEDURES?

Yes No (Ongoing no findings have yet been made)

If yes, was the organisation found to be in breach?

Yes No

If yes, please provide the following information:

DATES OF INVESTIGATION

BREACH (E.G. UNSUBSTANTIATED MARKETING CLAIMS)

OUTCOME

BRIEF SUMMARY OF PREVENTATIVE MEASURE (E.G. MODIFIED SALES SCRIPTS, MONITORED SALES STAFF CONDUCT)

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text.

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text. text.

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text.

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9.2 HAS THE APPLICANT ORGANISATION’S ADVERTISING OR MARKETING EVER BEEN INVESTIGATED BY THE ADVERTISING STANDARDS AUTHORITY?

Yes No Ongoing

If yes, was the organisation found to be in breach of their standards?

Yes No Ongoing

If yes, please provide the following information:

DATES OF INVESTIGATION

REFERENCE NUMBER

CIRCUMSTANCE (E.G. MISREPRESENTATIONS OR UNPROVEN CLAIMS ON WEBSITE)

BRIEF SUMMARY OF OUTCOME (E.G. WEBSITE CONTENT AMENDED OR EVIDENCE PROVIDED TO SUBSTANTIATE CLAIM)

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text.

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text.

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9.3 WHICH OF THE FOLLOWING STRATEGIES WILL BE THE PRIMARY

METHODS EMPLOYED FOR MARKETING AND SELLING THE ECO OR

NON-DOMESTIC GREEN DEAL PLANS?

(Please select all that apply and rate in order of importance, 1 being the most important).

Print media (e.g. newspaper adverts)

TV Advertising Regional National

Radio advertising Regional National

Leaflet/flyer distribution

Industry exhibits

Local events (e.g. local trade fairs)

Estate Agents

Housing Associations

Website/s

Search Engine Optimisation or equivalent

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Direct selling (e.g. door knocking)

Cold calling by Click here to enter text. This is an internal staff member external provider (tick one).

Lead Generators

Other Click here to enter text.

The above marketing materials will be produced by: Click here to enter text. This is an internal staff member

external provider (tick one).

9.4 PLEASE PROVIDE A SUMMARY OF THE INFORMATION THE APPLICANT

ORGANISATION WILL PROVIDE IN ITS SALES MATERIAL AND HOW IT

WILL COMPLY WITH THE GREEN DEAL CODE OF PRACTICE (COP)

Click here to enter text.

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9.5 HOW THE APPLICANT ORGANISATION PLANS TO ENSURE THAT

MARKETING AND SALES ARE CARRIED OUT IN ACCORDANCE WITH ALL

APPLICABLE CONSUMER PROTECTION LEGISLATION, THE ASA CODES

AND THE GD COP.

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9.6 PLEASE PROVIDE THE DETAILS OF THE INDIVIDUAL WHO WILL BE

RESPONSIBLE FOR ENSURING THE MARKETING MATERIAL IS

COMPLIANT WITH RELEVANT LEGISLATION:

Click here to enter text.

9.7 PLEASE PROVIDE THE FOLLOWING INFORMATION ABOUT

MARKETING/SALES STAFF TRAINING ON RELEVANT LEGISLATION:

Training will be provided: face to face online

Frequency of training inductions available: Choose an item. Days Choose an item. Months Choose an item. Years

Frequency of refresher courses: Choose an item. Days Choose an item. Months Choose an item. Years

Person responsible for training: Click here to enter job title.

This is an Choose an item.

Marketing and Sales topics that will be covered in the compliance training: Click here to enter text.

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9.8 ALONGSIDE SALES STAFF TRAINING, HOW WILL THE APPLICANT

ORGANISATION ENSURE STAFF REMAIN COMPLIANT WITH ABOVE

LEGISLATION?

Staff handbook/guidance documents on legislative requirements and compliance

Managerial sign-off of marketing material

Cold calls will be recorded/monitored

Randomised staff assessments/tests

Other:

9.9 IF THE APPLICANT ORGANISATION IS USING LEAD GENERATORS, COLD

CALLING AND/OR OTHER DIRECT SELLING TECHNIQUES, PLEASE

PROVIDE DETAILS ON HOW IT WILL ENSURE THEY COMPLY WITH THE

GD COP.

Click here to enter text.

9.10 WILL SALES STAFF MEMBERS RECEIVE INCENTIVES (FINANCIAL OR

OTHERWISE) FOR SALES GENERATED?

Financial Other Click here to enter text.

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Click here to enter text.

10. AGREEMENTS

GREEN DEAL CODE OF PRACTICE, GREEN DEAL ARRANGEMENTS AGREEMENT, OMBUDSMAN AND EPC REGISTER

Please tick all four boxes to confirm that you have read, understood and agree to do the following, if authorised.

Green Deal Providers must:

Comply with the Green Deal Code of Practice (GD CoP)

Participate in the Green Deal Ombudsman and Investigation Service

Enter into and comply with the Green Deal Arrangements Agreement (GDAA)

Obtain access to EPC register

Unless you confirm your understanding and agree to adhere to the above if authorised, your application will not

be processed.

To make you aware, Applicant Organisation names will be shared with the Green Deal Ombudsman in order to

expedite the registration process.

11. SUPPLY CHAIN MANAGEMENT

Please set out the applicant organisation’s policy and practices in relation to its dealings with the supply chain, of

particular interest are negotiating practices, prompt payment and communication.

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11.1 WILL THE APPLICANT ORGANISATION HAVE A SELECTION CRITERIA FOR

CHOOSING A SUPPLIER? MAX 200 WORDS.

Please summarise key considerations (e.g. previous experience, references, competitive pricing, accreditations,

financial position, health and safety policies, products and services offered etc.)

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11.2 WHAT WILL BE THE APPLICANT ORGANISATION’S PRIMARY FORM OF

COMMUNICATION WITH SUPPLIERS?

Email Phone Other Click here to enter text.

11.2.1 PLEASE PROVIDE THE DETAILS OF THE INDIVIDUAL RESPONSIBLE FOR MANAGING GD SUPPLIER RELATIONS:

Click here to enter job title.

11.3 WHAT WILL BE THE APPLICANT ORGANISATION’S NEGOTIATION

PRACTICES AFTER A SUPPLIER IS SELECTED? (E.G. REGARDING PRICE,

TERMS AND CONDITIONS – INCLUDING PAYMENT TERMS)

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11.4 HOW WILL THE APPLICANT ORGANISATION ENSURE SUPPLIER

SATISFACTION?

In person meetings, frequency Click here to enter text.

Feedback surveys

Follow up contact (phone call/email/letter)

Contract Terms and Conditions

Other Click here to enter text.

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11.5 WHAT WILL BE THE APPLICANT ORGANISATION’S PROCESS FOR

HANDLING SUPPLIER CONCERNS AND/OR FEEDBACK?

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11.6 WILL THE APPLICANT ORGANISATION BE A SIGNATORY TO THE PROMPT

PAYMENT CODE?

Yes No

If no, what will be the standard payment timescale: Choose an item. Days Choose an item. Months Choose an item. Years

11.7 WHAT IS THE APPLICANT ORGANISATION’S INTERNAL PROCEDURE

FROM RECEIVING AN INVOICE THROUGH TO PAYMENT?

Please include relevant job titles, internal checks and timescales.

Click here to enter text.

11.8 DOES THE APPLICANT ORGANISATION HAVE A SYSTEM IN PLACE TO

MAINTAIN QUOTES RECORDS AND INVOICES?

Please provide a brief summary.

Click here to enter text.

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11.9 PLEASE PROVIDE DETAILS OF TRAINING THE APPLICANT

ORGANISATION WILL BE OFFERING TO ITS STAFF IN RELATION TO THE

GREEN DEAL TO MAKE SURE THEY ARE COMPLIANT TO GREEN DEAL

STANDARDS:

Click here to enter text.

11.10 PLEASE PROVIDE THE FOLLOWING INFORMATION ABOUT SUPPLY

CHAIN STAFF TRAINING ON RELEVANT LEGISLATION:

Training will be provided: Face to face Online

Frequency of training refresher courses: Choose an item. Days Choose an item. Months Choose an item.

Years

Person responsible for training: Click here to enter job title.

Green Deal topic list for compliance training.

Click here to enter text.

11.11WILL YOU PROVIDE THE ABOVE TRAINING TO SUPPLIERS?

Yes No

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11.12 HOW WILL THE APPLICANT ORGANISATION KEEP STAFF/SUPPLIERS

UP TO DATE ON GREEN DEAL/ECO POLICY DEVELOPMENTS?

Training

Staff newsletter

Website update

Email

Staff Meeting

Other Click here to enter text.

11.13 HOW WILL THE APPLICANT ORGANISATION ENSURE SUPPLY CHAIN

STAFF COMPLY WITH RELEVANT LEGISLATION, THE GD COP AND

COMPANY POLICIES?

Handbook/guidance documents

Internal auditing/monitoring of supplier conduct, frequency Click here to enter text.

External auditing, frequency Click here to enter text.

Accreditation scheme: Click here to enter text.

Contract Terms and Conditions

Other: Click here to enter text.

11.14 IF NON-COMPLIANCE IS DETECTED, WHAT STEPS WILL BE TAKEN?

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11.15 THE PERSON RESPONSIBLE FOR COMPLIANCE IS:

Click here to enter job title.

12. CUSTOMER SERVICES AND COMPLAINTS HANDLING

Please provide a summary of the number of customer complaints made in relation to the applicant organisation in the last three years. Where possible please provide numbers and an indication of customer base, breaking this down into the different categories of complaint and indicating in relation to each category how many complaints have been resolved.

(Click here to enter text. ) Total number of Green Deal related complaints over last three years, of

which:

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(Click here to enter text. ) Related to off-premises selling (sales activities that take place away from

the applicant organisation’s premises); and

(Click here to enter text. ) Related to ongoing customer service and contact where the applicant

organisation has a long relationship with a customer.

12.1 PLEASE CONFIRM THAT THE APPLICANT ORGANISATION’S SPECIFIC

COMPLAINTS HANDLING PROCEDURE IS INCLUDED IN THIS

APPLICATION.

Procedure documentation is included

This should be a step-by-step guide for staff, including how complaints are received and responded to,

timescales, methods of communication, monitoring arrangements, escalation and resolution procedures. (Please

see GD CoP 4.17-4.25)

12.2 HOW MANY OF THESE CUSTOMER COMPLAINTS HAVE BEEN

REFERRED TO THE OMBUDSMAN SERVICES IN THE LAST THREE

YEARS?

Choose an item. Complaints

Please provide the complaint and outcome for each of these referrals (please ensure examples adhere to

relevant data protection policies):

DATE COMPLAINT CATEGORY BRIEF SUMMARY OF OUTCOME/PREVENTATIVE MEASURE

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enter text.

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enter text.

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enter text.

Click here to enter text. Click here to enter text.

If you are a new company with no complaints data, do any Directors have any experience of complaints

handling? Click here to enter text.

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12.3 WHAT IS THE APPLICANT ORGANISATION’S PROCESS FOR HANDLING

GENERAL CUSTOMER QUERIES (NOT INCLUDING COMPLAINTS)?

Please include timescales, job titles, methods of communication, monitoring arrangements, escalation and

resolution procedures:

Click here to enter text.

12.4 HOW WILL CUSTOMERS BE ABLE TO SUBMIT ENQUIRIES?

Telephone number

Email address

Website form

Social Media site

Other Click here to enter text.

13. DATA PROTECTION AND INFORMATION SECURITY

How does the applicant organisation plan to ensure that its Green Deal related activities meet its data protection obligations, including how Green Deal information is kept securely and maintained to appropriate standards? Please provide evidence of relevant policies and procedures.

13.1 PERSON RESPONSIBLE FOR DATA PROTECTION AND INFORMATION

SECURITY:

Click here to enter job title.

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13.2 HOW WILL THE APPLICANT ORGANISATION ENSURE THE DATA

PROTECTION AND INFORMATION SECURITY POLICIES ARE ADHERED

TO?

Click here to enter text.

13.3 HOW WILL STAFF RECEIVE TRAINING ON DATA PROTECTION AND

INFORMATION SECURITY?

Training will be provided: Face to face Online

Frequency of training courses: Choose an item. Days Choose an item. Months Choose an item. Years

13.4 HOW WILL STAFF BE UPDATED ON NEW INFORMATION REGARDING

COMPLIANCE WITH THE DATA PROTECTION ACT 1998?

Training

Staff newsletter

Website update

Email

Staff meeting

Other Click here to enter text.

13.5 HOW OFTEN WILL THE DATA PROTECTION AND INFORMATION

SECURITY POLICIES BE REVIEWED AND UPDATED?

Choose an item. Days Choose an item. Months Choose an item. Years

13.6 IF NON-COMPLIANCE IS DETECTED, WHAT STEPS WILL BE TAKEN?

Click here to enter text.

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13.7 IS THE APPLICANT ORGANISATION CURRENTLY REGISTERED WITH THE

INFORMATION COMMISSIONERS OFFICE (ICO)?

Yes: ICO Registration Number Click here to enter text.

No

Registration Pending: ICO Reference Number Click here to enter text.

14. HEALTH AND SAFETY

How will the applicant organisation ensure that Green Deal related processes comply with health and safety legislation? Please provide evidence of Health and Safety policies and procedures.

14.1 PERSON RESPONSIBLE FOR HEALTH AND SAFETY:

Click here to enter job title.

14.2 HOW WILL THE APPLICANT ORGANISATION ENSURE HEALTH AND

SAFETY POLICIES ARE ADHERED TO?

Click here to enter text.

14.3 HOW WILL STAFF RECEIVE TRAINING ON HEALTH AND SAFETY?

Training will be provided: Face to face Online

Frequency of training courses: Choose an item. Days Choose an item. Months Choose an item. Years

14.4 HOW WILL STAFF BE UPDATED ON NEW INFORMATION REGARDING

HEALTH AND SAFETY POLICIES?

Training

Staff newsletter

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Website update

Staff meeting

Email

Other Click here to enter text.

14.5 HOW OFTEN WILL THE HEALTH AND SAFETY POLICIES BE REVIEWED

AND UPDATED?

Choose an item. Days Choose an item. Months Choose an item. Years

14.6 IF NON-COMPLIANCE IS DETECTED, WHAT STEPS WILL BE TAKEN?

Click here to enter text.

15. REFERENCE

Please provide contact details for two references from previous business associates, organisations you have

purchased goods and services from, or you have supplied goods and services to.

REFEREE 1:

Referee Company Name:Click here to enter text.

Referee Telephone Number: Click here to enter text.

Referee Email Address: Click here to enter text.

How Long Have You Been Associated With This Reference?:

Click here to enter text.

Referee Relationship: Click here to enter text.

REFEREE 2:

Referee Company Name:Click here to enter text.

Referee Telephone Number: Click here to enter text.

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Referee Email Address: Click here to enter text.

How Long Have You Been Associated With This Reference?:

Click here to enter text.

Referee Relationship: Click here to enter text.

16. DECLARATION

I declare that the information I have provided in this form, and in all supporting documentation, is true and

accurate and I have not knowingly presented information in a misleading manner.

I can provide evidence to corroborate all the information recorded, or will be able to identify parties that can do

so.

I confirm that I am authorised to act on behalf of the Applicant Organisation and that I have completed this form in that capacity.

Signature*:

* Please sign or insert your electronic signature.

Print Name: Click here to enter text.

Role in Applicant Organisation: Click here to enter text.

Date (dd/mm/yyyy): Click here to enter text.

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