Low-Income Household Energy Subsidy Audit Form
1. Household Information
Head of Household Name
Household Address
Contact Number
Number of Household Members
2. Subsidy Information
Subsidy Program Name
Audit Period
Total Subsidy Amount Received
3. Energy Consumption
Type of Energy Source
Average Monthly Energy Usage (kWh or units)
4. Supporting Documents
Documents Submitted (Checklist)
5. Auditor Verification
Auditor Name
Audit Date
Remarks