Homeless Referral Evidence Form

Progress

Before you begin
Has a housing referral application already been submitted for the applicant?

You must complete a housing referral application before you can provide the evidence for this form.

You must complete a housing referral application before you can provide the evidence for this form.

Details of applicant

Given name

Family name

(dd/mm/yyyy)

Evidence

The evidence you need to provide if you have not already provided it with the housing referral application you submitted is:

This can be an employment slip or benefit award letter. Please add here if not already provided.

This can be a contract of employment or recent wage slip. Please add here if not already provided and applicant is employed.

This could consist of any of the following: award letters, screen shot of your universal credit journal, bank statements showing benefit payments. Please add here if not already provided and applicant is unemployed.

Evidence can be in the form of formal documents or notices or can be informal letters or notes from family or friends confirming that they have asked applicant to leave. Please add here if you have not already provided this.

The following evidence that is needed depends on individual circumstances and only some of it may be relevant and required for this application.

This can be a crime reference number, police report or any other evidence you have that shows the applicant is fleeing domestic abuse. Please add here if fleeing domestic abuse and you have not already provided this.

This can be an emergency services report, insurance documents or any other type of evidence that shows applicant is fleeing fire or flooding. Please add here if fleeing fire or flooding and have not already provided this.

Please provide a copy of the MATB1 form or any additional medical evidence that confirms the pregnancy. Please add here if applicant or anyone else in their household is pregnant and this has not already been provided.

Proof could consist of any of the following: Medical reports, Letter from GP, Sick note, Hospital records, Prescription details or Proof of DLA/ PIP. Please add here if applicant has a health, disability or special need and not already provided.

This can be Immigration documents confirming positive refugee status or a passport. Please add here if applicant has been granted indefinite leave to remain in the UK and have not already provided this.

Please add here if partner details were added in their referral and you have not already provided employment or unemployment status evidence.

This should be a copy of section 21 or Section 8 eviction notice and any additional letters/ notices the applicant’s landlord may have issued regarding the eviction. Please add here if not already provided.

Please provide evidence of rent arrears and any additional letters/notices the applicant's landlord may have issued regarding the eviction as a result of rent arrears. Please add here if in rent arrears and not already provided.

Before you submit this form please review your answers below. If you need to change anything, use the 'previous' button on the bottom left to go back to a section. Then submit the form by selecting the 'Submit button' at the bottom of this page