Prior to Submitting This Pre-Assessment Questionnaire (PAQ), Applicants Wishing to Apply For

Green Deal Provider Authorisation

Pre-Assessment Questionnaire

Prior to submitting this Pre-assessment Questionnaire (PAQ), Applicants wishing to apply for

domestic authorisation must contact the Financial Conduct Authority (FCA) to obtain the requisite consumer credit permissions to operate as a Green Deal Provider.

For further information please visit

Please note that the Green Deal Oversight and Registration Body (GD ORB) is unable to process applications which do not hold the requisite permissions.

Prior to completing this PAQ, 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: details.

For information regarding estimated costs and indicative timescales for becoming a Green Deal Provider, please refer to the ‘Guidance for Applicants’ document which can be found on the GD ORB website.

Authorised Green Deal Providers will be subject to on-going monitoring against the Green Deal Code of Practice (CoP). Monitoring may include, but not be limited to, compliance visits and mystery shopping. Monitoring activity may be recorded.

This PAQ is to 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 types of Applicant Organisations.

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

Completed PAQs must be submitted electronically via email to: .

Electronic signatures are acceptable.

Any queries regarding this PAQ should be directed to the (GD ORB) helpdesk via:

1.APPLICATION AND ADMINISTRATION DETAILS

1.1Corporate 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) / Click here to enter text. /
Nature of Applicant Organisation’s Legal Structure (e.g. Company Limited Liability Partnership) / Click here to enter text. /
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 Registered Company Directors: / Click here to enter text. /
Operational Contact for Green Deal Provider Authorisation Process (Name, Contact number and Email) : / Click here to enter text. /

2.PREVIOUS APPLICATIONS

2.1Previous Applications

Has your business, any director, manager or shareholder applied for Green Deal Provider authorisation previously? Please tick as appropriate:

No (please continue to section 2.2)

Yes (please provide details below)

Name of Organisation / Individual that Previously Applied / Date(s) of Previous Application(s) / Previous Application Number(s) (GDPA)
Click here to enter text. / Click here to enter text. / Click here to enter text. /
Click here to enter text. / Click here to enter text. / Click here to enter text. /
Click here to enter text. / Click here to enter text. / Click here to enter text. /

Reason for new application:

Voluntary withdrawal

Rejected

Other (please specify) Click here to enter text.

If your organisation was not authorised as a result of the previous application(s), please briefly explain why.

Click here to enter text.

2.2Associated Applicants

To the best of your knowledge, 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:

YesNo

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.

3.LICENSING

3.1Consumer Credit Act

Authorisation may be sought in respect of both domestic properties AND non-domestic properties OR of non-domestic properties only. Please indicate your choice:

Both Domestic AND Non-Domestic Properties

*Non-Domestic Properties Only

*Organisations applying for authorisation in respect of non-domestic properties only, do not require permissions for consumer credit.

3.2FCA Permissions

In order to become an authorised Domestic Green Deal Provider your organisation must hold the requisite FCA permissions to allow you to operate in the market place. Please note: It is the responsibility of the Applicant to apply for and obtain the requisite permissions from the FCA.

Please provide the following information:

Firm Reference Number: / Click here to enter text. /
Effective Date: / Click here to enter text. /
Activity Names Covered Under FCA Permissions: (REQUIRED for Applicants Who Wish to be Authorised in Respect of Domestic Properties) / Click here to enter text. /

4.ESTIMATED NUMBER OF GREEN DEAL PLANS

In its first year as a Provider, how many Green Deal Plans is the organisation anticipated to enter into?

Click here to enter text.Green Deal Plans

Please provide a brief explanation (100 words max):

Click here to enter text.

5.FINANCE

How does your organisation plan to source finance if authorised as a Green Deal Provider? Please tick as appropriate:

The Green Deal Finance Company (GDFC)

Other (provide details):

Click here to enter text.

If your organisation is considering obtaining finance from the GDFC, should you consent, the GD ORB is able to share any information provided in your application (Pre-Assessment Questionnaire, Fitness Test and supporting information) with the GDFC for the purpose of on boarding (i.e. the application process and checks necessary to qualify for finance from the GDFC).

This may reduce the amount of information sought from your organisation when registering with the GDFC. This is without prejudice to finance if consent not given.

Please tick this box if you consent

6.AGREEMENTS

6.1Green 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.

7.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:

Please Note: The Fitness Test will not be provided until the GD ORB has received satisfactory references.

8. 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.

Appendix: Further Supporting Information

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

Great Britain or:

England

Wales

Scotland

Green Deal Provider Authorisation Pre-Assessment Questionnaire V:2.0