Homeless Referral Evidence Form

Progress

Before you begin

You must have already submitted a homeless application in order to complete this form.

Have you already submitted a homeless application?

You must not use this form if you have not already done so.

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

Please do not continue with this form, as it cannot be submitted.

Details of applicant

Given name

Family name

(dd/mm/yyyy)

Upload evidence now

Please upload any relevant evidence you were unable to provide when you submitted your homeless application. Do not resend evidence you have already submitted with the application.

This can be a passport, driving licence or birth certificate.

This can be an employment slip or benefit award letter.

This can be a contract of employment or recent wage slip.

This can be any of the following: an award letter, screenshot of a universal credit journal, or recent bank statements showing benefit payments.

This can be a formal or informal note or letter which confirms family or friends have asked the applicant to leave.

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 that shows the applicant is fleeing domestic abuse.

This can be an emergency services report, insurance documents or any other type of evidence that shows the applicant is fleeing fire or flooding.

Please provide a copy of the MATB1 form for the applicant or anyone else in their household who is pregnant, or any additional medical evidence that confirms the pregnancy.

This can be medical reports, a letter from a GP, a sick note, hospital records, prescription details or proof of DLA/PIP.

This can be immigration documents confirming positive refugee status, or a passport.

If employed, this can be wage slips or a contract of employment. If unemployed, this can be a benefit award letter, screenshots of a Universal Credit journal, or recent bank statements showing benefit payments.

This should be a copy of the Section 21 or Section 8 eviction notice and any additional letters or notices the applicant’s landlord has issued regarding the eviction.

Please provide evidence of rent arrears and any additional letters or notices the applicant's landlord may have issued regarding the eviction as a result of rent arrears.

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