{"id":482,"date":"2022-04-26T16:02:27","date_gmt":"2022-04-26T16:02:27","guid":{"rendered":"https:\/\/www.cleanenergynationwide.co.uk\/?page_id=482"},"modified":"2023-10-10T09:54:19","modified_gmt":"2023-10-10T09:54:19","slug":"contact-us","status":"publish","type":"page","link":"https:\/\/www.cleanenergynationwide.co.uk\/contact-us\/","title":{"rendered":"Contact Us"},"content":{"rendered":"[vc_row type=&#8221;full_width_background&#8221; full_screen_row_position=&#8221;middle&#8221; column_margin=&#8221;default&#8221; equal_height=&#8221;yes&#8221; column_direction=&#8221;default&#8221; column_direction_tablet=&#8221;default&#8221; column_direction_phone=&#8221;default&#8221; bg_image=&#8221;1076&#8243; bg_position=&#8221;center center&#8221; background_image_loading=&#8221;default&#8221; bg_repeat=&#8221;no-repeat&#8221; scene_position=&#8221;center&#8221; top_padding=&#8221;10%&#8221; bottom_padding=&#8221;3%&#8221; top_padding_tablet=&#8221;13%&#8221; 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column_border_style=&#8221;solid&#8221; gradient_type=&#8221;default&#8221;][vc_column_text]\n<h4>Our Address<\/h4>\n<p>Empire Business Park<br \/>\nOffice 103<br \/>\nBurnley<br \/>\nBB12 6HH[\/vc_column_text][\/vc_column_inner][vc_column_inner column_padding=&#8221;no-extra-padding&#8221; column_padding_tablet=&#8221;inherit&#8221; column_padding_phone=&#8221;inherit&#8221; column_padding_position=&#8221;all&#8221; column_element_spacing=&#8221;default&#8221; background_color_opacity=&#8221;1&#8243; background_hover_color_opacity=&#8221;1&#8243; column_shadow=&#8221;none&#8221; column_border_radius=&#8221;none&#8221; column_link_target=&#8221;_self&#8221; advanced_gradient_angle=&#8221;0&#8243; gradient_direction=&#8221;left_to_right&#8221; overlay_strength=&#8221;0.3&#8243; width=&#8221;1\/2&#8243; tablet_width_inherit=&#8221;small_desktop&#8221; animation_type=&#8221;default&#8221; bg_image_animation=&#8221;none&#8221; border_type=&#8221;simple&#8221; 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gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_safari gf_browser_iphone gform_wrapper gravity-theme' id='gform_wrapper_5' style='display:none'><div id='gf_5' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_5' id='gform_5'  action='\/wp-json\/wp\/v2\/pages\/482#gf_5' >\n        <div id='gf_progressbar_wrapper_5' class='gf_progressbar_wrapper'>\n        \t<p class=\"gf_progressbar_title\">Step <span class='gf_step_current_page'>1<\/span> of <span class='gf_step_page_count'>2<\/span>\n        \t<\/p>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_50' style='width:50%;'><span>50%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform_body gform-body'><div id='gform_page_5_1' class='gform_page' >\n                                    <div class='gform_page_fields'><div id='gform_fields_5' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_5_13\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_5_13' >I am a...<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_13' id='input_5_13' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select an option<\/option><option value='Homeowner' >Homeowner<\/option><option value='Landlord' >Landlord<\/option><option value='Tenant' >Tenant<\/option><option value='Estate Agent' >Estate Agent<\/option><\/select><\/div><\/div><div id=\"field_5_15\" class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\" ><h3 class=\"gsection_title\">Homeowner Information<\/h3><\/div><fieldset id=\"field_5_1\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_hidden_label field_description_below gfield_visibility_visible\" ><legend class='gfield_label gfield_label_before_complex'  >Full Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name' id='input_5_1'>\n                            \n                            <span id='input_5_1_3_container' class='name_first' >\n                                                    <input type='text' name='input_1.3' id='input_5_1_3' value=''   aria-required='true'   placeholder='First Name'  \/>\n                                                    <label for='input_5_1_3' class='hidden_sub_label screen-reader-text'>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_5_1_6_container' class='name_last' >\n                                                    <input type='text' name='input_1.6' id='input_5_1_6' value=''   aria-required='true'   placeholder='Last Name'  \/>\n                                                    <label for='input_5_1_6' class='hidden_sub_label screen-reader-text'>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_5_19\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_hidden_label field_description_below gfield_visibility_visible\" ><legend class='gfield_label gfield_label_before_complex'  >Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_zip ginput_container_address' id='input_5_19' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1' id='input_5_19_1_container' >\n                                        <input type='text' name='input_19.1' id='input_5_19_1' value=''   placeholder='Street Address' aria-required='true'    \/>\n                                        <label for='input_5_19_1' id='input_5_19_1_label' class='hidden_sub_label screen-reader-text'>Street Address<\/label>\n                                    <\/span><input type='hidden' class='gform_hidden' name='input_19.4' id='input_5_19_4' value=''\/><span class='ginput_right address_zip ginput_address_zip' id='input_5_19_5_container' >\n                                    <input type='text' name='input_19.5' id='input_5_19_5' value=''   placeholder='Post Code' aria-required='true'    \/>\n                                    <label for='input_5_19_5' id='input_5_19_5_label' class='hidden_sub_label screen-reader-text'>ZIP \/ Postal Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_19.6' id='input_5_19_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_5_21\" class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_5_21' >Email Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_21' id='input_5_21' type='text' value='' class='large'   placeholder='Email Address' aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_5_22\" class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_5_22' >Contact Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_22' id='input_5_22' type='text' value='' class='large'  placeholder='Contact Number' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_38\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_5_38' >Date of Birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_38' id='input_5_38' type='text' value='' class='datepicker dmy datepicker_no_icon gdatepicker-no-icon'   placeholder='dd\/mm\/yyyy' aria-describedby=\"input_5_38_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_5_38_date_format' class='screen-reader-text'>DD slash MM slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_5_38' class='gform_hidden' value='https:\/\/www.cleanenergynationwide.co.uk\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><fieldset id=\"field_5_23\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label gfield_label_before_complex'  >Select Benefits<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_5_23'><div class='gchoice gchoice_5_23_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_23.1' type='checkbox'  value='Child Tax Credits (CTC)'  id='choice_5_23_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_23_1' id='label_5_23_1'>Child Tax Credits (CTC)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_23_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_23.2' type='checkbox'  value='Child Benefits - depends on income threshold*'  id='choice_5_23_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_23_2' id='label_5_23_2'>Child Benefits - depends on income threshold*<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_23_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_23.3' type='checkbox'  value='Jobseekers Allowance (JSA)'  id='choice_5_23_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_23_3' id='label_5_23_3'>Jobseekers Allowance (JSA)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_23_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_23.4' type='checkbox'  value='Employment &amp; Support Allowance (ESA)'  id='choice_5_23_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_23_4' id='label_5_23_4'>Employment & Support Allowance (ESA)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_23_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_23.5' type='checkbox'  value='Income Support (IS)'  id='choice_5_23_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_23_5' id='label_5_23_5'>Income Support (IS)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_23_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_23.6' type='checkbox'  value='Pension Credit Guarantee Credit'  id='choice_5_23_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_23_6' id='label_5_23_6'>Pension Credit Guarantee Credit<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_23_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_23.7' type='checkbox'  value='Universal Credit (UC)'  id='choice_5_23_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_23_7' id='label_5_23_7'>Universal Credit (UC)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_23_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_23.8' type='checkbox'  value='Warm Home Discount Scheme Rebate'  id='choice_5_23_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_23_8' id='label_5_23_8'>Warm Home Discount Scheme Rebate<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_23_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_23.9' type='checkbox'  value='Working Tax Credit (WTC)'  id='choice_5_23_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_23_9' id='label_5_23_9'>Working Tax Credit (WTC)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_23_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_23.11' type='checkbox'  value='Housing Benefit'  id='choice_5_23_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_23_11' id='label_5_23_11'>Housing Benefit<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_5_16\" class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\" ><h3 class=\"gsection_title\">Landlord Information<\/h3><\/div><fieldset id=\"field_5_24\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_hidden_label field_description_below gfield_visibility_visible\" ><legend class='gfield_label gfield_label_before_complex'  >Full Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name' id='input_5_24'>\n                            \n                            <span id='input_5_24_3_container' class='name_first' >\n                                                    <input type='text' name='input_24.3' id='input_5_24_3' value=''   aria-required='true'   placeholder='First Name'  \/>\n                                                    <label for='input_5_24_3' class='hidden_sub_label screen-reader-text'>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_5_24_6_container' class='name_last' >\n                                                    <input type='text' name='input_24.6' id='input_5_24_6' value=''   aria-required='true'   placeholder='Last Name'  \/>\n                                                    <label for='input_5_24_6' class='hidden_sub_label screen-reader-text'>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_5_25\" class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_5_25' >Email Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_25' id='input_5_25' type='text' value='' class='large'   placeholder='Email Address' aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_5_26\" class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_5_26' >Contact Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_26' id='input_5_26' type='text' value='' class='large'  placeholder='Contact Number' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_27\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_5_27' >Number of Properties<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_27' id='input_5_27' type='text'    value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_5_17\" class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\" ><h3 class=\"gsection_title\">Tenant Information<\/h3><\/div><fieldset id=\"field_5_28\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_hidden_label field_description_below gfield_visibility_visible\" ><legend class='gfield_label gfield_label_before_complex'  >Full Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name' id='input_5_28'>\n                            \n                            <span id='input_5_28_3_container' class='name_first' >\n                                                    <input type='text' name='input_28.3' id='input_5_28_3' value=''   aria-required='true'   placeholder='First Name'  \/>\n                                                    <label for='input_5_28_3' class='hidden_sub_label screen-reader-text'>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_5_28_6_container' class='name_last' >\n                                                    <input type='text' name='input_28.6' id='input_5_28_6' value=''   aria-required='true'   placeholder='Last Name'  \/>\n                                                    <label for='input_5_28_6' class='hidden_sub_label screen-reader-text'>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_5_29\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_5_29' >Contact Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_29' id='input_5_29' type='text' value='' class='large'  placeholder='Contact Number' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_30\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_5_30' >Date of Birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_30' id='input_5_30' type='text' value='' class='datepicker dmy datepicker_no_icon gdatepicker-no-icon'   placeholder='dd\/mm\/yyyy' aria-describedby=\"input_5_30_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_5_30_date_format' class='screen-reader-text'>DD slash MM slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_5_30' class='gform_hidden' value='https:\/\/www.cleanenergynationwide.co.uk\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><fieldset id=\"field_5_31\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_hidden_label field_description_below gfield_visibility_visible\" ><legend class='gfield_label gfield_label_before_complex'  >Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_zip ginput_container_address' id='input_5_31' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1' id='input_5_31_1_container' >\n                                        <input type='text' name='input_31.1' id='input_5_31_1' value=''   placeholder='Street Address' aria-required='true'    \/>\n                                        <label for='input_5_31_1' id='input_5_31_1_label' class='hidden_sub_label screen-reader-text'>Street Address<\/label>\n                                    <\/span><input type='hidden' class='gform_hidden' name='input_31.4' id='input_5_31_4' value=''\/><span class='ginput_right address_zip ginput_address_zip' id='input_5_31_5_container' >\n                                    <input type='text' name='input_31.5' id='input_5_31_5' value=''   placeholder='Post Code' aria-required='true'    \/>\n                                    <label for='input_5_31_5' id='input_5_31_5_label' class='hidden_sub_label screen-reader-text'>ZIP \/ Postal Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_31.6' id='input_5_31_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_5_32\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_5_32' >Tenure (Home owner, tenant)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_32' id='input_5_32' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_5_33\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label gfield_label_before_complex'  >Select Benefits<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_5_33'><div class='gchoice gchoice_5_33_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.1' type='checkbox'  value='Child Tax Credits (CTC)'  id='choice_5_33_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_33_1' id='label_5_33_1'>Child Tax Credits (CTC)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_33_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.2' type='checkbox'  value='Child Benefits - depends on income threshold*'  id='choice_5_33_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_33_2' id='label_5_33_2'>Child Benefits - depends on income threshold*<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_33_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.3' type='checkbox'  value='Jobseekers Allowance (JSA)'  id='choice_5_33_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_33_3' id='label_5_33_3'>Jobseekers Allowance (JSA)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_33_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.4' type='checkbox'  value='Employment &amp; Support Allowance (ESA)'  id='choice_5_33_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_33_4' id='label_5_33_4'>Employment & Support Allowance (ESA)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_33_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.5' type='checkbox'  value='Income Support (IS)'  id='choice_5_33_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_33_5' id='label_5_33_5'>Income Support (IS)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_33_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.6' type='checkbox'  value='Pension Credit Guarantee Credit'  id='choice_5_33_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_33_6' id='label_5_33_6'>Pension Credit Guarantee Credit<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_33_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.7' type='checkbox'  value='Universal Credit (UC)'  id='choice_5_33_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_33_7' id='label_5_33_7'>Universal Credit (UC)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_33_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.8' type='checkbox'  value='Warm Home Discount Scheme Rebate'  id='choice_5_33_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_33_8' id='label_5_33_8'>Warm Home Discount Scheme Rebate<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_33_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.9' type='checkbox'  value='Working Tax Credit (WTC)'  id='choice_5_33_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_33_9' id='label_5_33_9'>Working Tax Credit (WTC)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_33_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.11' type='checkbox'  value='Housing Benefit'  id='choice_5_33_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_33_11' id='label_5_33_11'>Housing Benefit<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_33_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.12' type='checkbox'  value='Pension Credit Saving Credit'  id='choice_5_33_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_33_12' id='label_5_33_12'>Pension Credit Saving Credit<\/label>\n\t\t\t\t\t\t\t<\/div><div 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