An application for assistance shall be in writing and shall contain the following:—
(a) the name and address of the person applying for assistance,
(b) the address of the dwelling to which it relates,
(c) a description of the works stating for which one or more of the purposes specified in regulation 3(1) below they are to be carried out,
(d) the name and address of the person who will carry out the works,
(e) an estimate of the cost of the works and, if the works are to be carried out by the applicant, of the cost of the materials to be used in carrying them out,
(f) confirmation that the works are not, so far as the applicant is aware, the subject of or included in any other application for assistance or for grant under Part VIII of the Act,
(g) details of the amount or value of any assistance given in the period of three years preceding the date of the application in respect of the dwelling,
(h) a statement as to which of the conditions in regulation 4 below are satisfied, and
(i) the signature of the applicant.