GREEN DEAL PROVIDER AUTHORISATION PRE-ASSESSMENT
QUESTIONNAIRE
To Note: Prior to completing this Pre-assessment Questionnaire (PAQ),
applicants are requested to read the Guidance for Applicants and Green Deal
Framework Regulations 2012 V1.0 accompanying this document.
If you have any queries regarding this PAQ please contact the Green Deal Oversight and
Registration Body (GD ORB) helpdesk by email at gdproviderapplications@gemserv.com
We reserve the right to request additional information from your organisation in order to
assist with the PAQ.
This PAQ is to be completed by:(a) a Company Director, where the applicant is a company;
(b) a person with the appropriate authority, for all other applicants
PAQs should be submitted electronically via email to gdproviderapplications@gemserv.com.
Electronic signatures are therefore acceptable.
By applying to becoming a Green Deal Provider, applicants are agreeing to be monitored
against the Green Deal Code of Practice (GD CoP). Monitoring may involve a range of
techniques including; compliance visits and mystery shopping. Monitoring activity may be
recorded.
Green Deal Provider Pre-Assessment Questionnaire
December 2012 V1.5
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1. APPLICATION AND ADMINISTRATION DETAILS
1.1
Corporate Information
Please provide up to date details in the table below. If the application is successful, these
details will be placed on the Green Deal Provider Register.
Applicant Name (registered company
name for a company):
Company Registration Number (if
applicable):
Registered address 1:
Registered address 2:
Registered address 3:
City/Town:
Postcode:
Country (England / Scotland / Wales):
Principal Trading Address 1 (If
different from registered address):
Principal Trading Address 2:
Principal Trading Address 3:
City/Town:
Green Deal Provider Pre-Assessment Questionnaire
December 2012 V1.5
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Postcode:
Country (England / Scotland / Wales):
Telephone Number:
Email:
Website:
Parent Company Name (If applicable):
Parent Company Trading Name (If
applicable and different to applicant’s
trading name):
Names of Registered Company
Directors:
Operational contact for Green Deal
Provider authorisation process (Name,
contact number and email) :
Contact details for customer enquiries
regarding Green Deal Plans (Name,
contact number and email if
available*) :
Contact details for customer
complaints regarding the Green Deal if
available (Name, contact number and
email if available*):
* (if not available, please provide this once authorised as this information will be required for public
display on GD ORB website and Green Deal Provider register)
Green Deal Provider Pre-Assessment Questionnaire
December 2012 V1.5
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2. LICENSING
2.1
Consumer Credit Act Licence
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
Please provide the number, issue date AND legal entity of your CCA
licence (REQUIRED for applicants who wish to be authorised in respect
of domestic properties) :
Category of Licence (a minimum of category A is required for a Green Deal Provider, unless a
local authority):
Category A: Consumer Credit Business
Category B: Consumer Hire Business
Category C: Credit Brokerage
Category D: Debt Adjusting
Category D2: Non – commercial debt
Category E: Debt Counselling
adjusting
Category E2: Non commercial Debt
Category F: Debt Collecting
Counselling
Category G: Debt Administration
Category H1: Provision of Credit
Information Services (Including credit repair)
Category H2: Provision of Credit
Information Services (Excluding credit repair)
Category H3: Provision of Credit
Information Services (Including noncommercial credit repair)
Category I: Credit Reference Agency
Canvassing Off Trade Premises
Currently applying for a CCA licence
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December 2012 V1.5
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If you are currently applying for a CCA Licence, please provide the date
you applied and the categories you applied for:
3. AGREEMENTS
3.1
Green Deal Code of Practice, Green Deal Arrangement Agreement,
Ombudsman and EPC Register
Green Deal Providers must comply with and enter in to the Green Deal Code of Practice (GD
CoP) and the Green Deal Arrangements Agreement (GDAA) and participate in the Green Deal
Ombudsman and Investigation Service. Unless you are able to confirm that you understand
this and, if authorised, will do so, your application will not be processed. To make you aware,
applicant organisation names will be shared with the Ombudsman in order to speed up the
registration process.
You will also need to obtain access to the EPC register if you are authorised, so your
organisation can place details of Green Deal Plans onto the EPC and update them as
appropriate.
Please tick all four boxes below to confirm that you have read, understood and agree to do
the following, if authorised:
comply with the Green Deal Code of
Practice (GD CoP
participate in the Green Deal
enter into and comply with the Green Deal
Arrangement Agreement (GDAA)
obtain access to EPC register
Ombudsman and Investigation Service
Green Deal Provider Pre-Assessment Questionnaire
December 2012 V1.5
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4. DECLARATION
I declare that the information I have provided in this form and all supporting documentation is
true and accurate and I have not 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 understand that, should my organisation become a Green Deal Provider:

My organisation will be required to comply with the Green Deal Code of Practice and the
Green Deal Arrangements Agreement and to participate in the Green Deal Ombudsman and
Investigation Service, and that failure to do so may result in the removal or review of
authorisation or other sanctions under the Green Deal Framework Regulations 2012.
I confirm that I am authorised to complete this form and act on behalf of the company to
make this application:
Signature*:
Print Name:
Role in applicant organisation:
Date:
* Please sign or insert your electronic signature.
Green Deal Provider Pre-Assessment Questionnaire
December 2012 V1.5
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APPENDIX
FURTHER SUPPORTING INFORMATION
Please indicate your organisation’s planned geographical coverage (Please tick all that apply):
National
OR:
England
All
London & South East
South West
West Midlands
East Midlands
East of England
Yorks and Humber
North West
North East
Wales
All
Blaenau Gwent
Bridgend
Caerphilly
Cardiff
Carmarthenshire
Ceredigion
Conwy
Denbighshire
Flintshire
Gwynedd
Isle of Anglesey
Merthyr Tydfil
Monmouthshire
Neath Port Talbot
Newport
Pembrokeshire
Powys
Rhondda Cynon Taf
Swansea
Torfaen
Vale of Glamorgan
Wrexham
Scotland
All
Aberdeen
Aberdeenshire
Angus
Argyll and Bute
Clackmannanshire
Dumfries and Galloway
Dundee
East Ayrshire
East Dunbartonshire
East Lothian District
East Renfrewshire
Edinburgh
Falkirk
Fife
Glasgow
Highland
Inverclyde
Midlothian
Moray
North Ayrshire
North Lanarkshire
Orkney Islands
Perth and Kinross
Renfrewshire
Scottish Borders
Shetland Islands
South Ayrshire
South Lanarkshire
Stirling
West Dunbartonshire
West Lothian
Western Isles
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December 2012 V1.5
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