Referral Form

Referral Form
Referrer Details
Name of Referrer*
Position
Referrers Email*
Referrer Telephone*
Referrer Organisation*
Referrer Organisation*
Referrer Organisation if not listed
Organisation Address
Is this referral from a Council/Local Authority, or Statutory Service?

YesNoOther
Does the individual have an accepted duty to be housed?

YesNoOther
Will the duty be retained if the individual is accepted by Safe Haven Sussex?

YesNoOther

Declaration
The following documents have been attached to this referral form*

Proof benefitID (Proof you have the Right to Rent)
Right to Rent
As an accommodation provider, Safe Haven Sussex has a duty to ensure prospective residents have the right to rent in the UK. One of the relevent documents will be required before the referral can be processed.
- a passport
- a travel document issued by the Home Office
- an immigration status document sent to you when you were given permission to stay in the UK
Your passport, travel document or immigration status document needs to have a Home Office endorsement in it - for example, a stamp or a vignette (a sticker).

This must say that you have one of the following:
- indefinite leave to enter or indefinite leave to remain in the UK
- no time limit to your stay in the UK
- a certificate of entitlement to the right of abode
- exemption from immigration control
- limited leave to enter or limited leave to remain in the UK, or permission to stay for a time limited period - this must cover the time you’ll be renting
- a certificate of entitlement to readmission to the UK
You can no longer use a physical biometric residence permit or card to prove your right to rent - you’ll need to get a share code instead.

If you cannot provide one of the above documents please contact the referrals officer who will be able to provide you with further instructions: Referrals@safehavensussex.org.uk
File Upload*

Cancelof
Referrer Declaration: I confirm that the information provided is correct at the time it was completed, and I understand that withholding information can delay the process and put the client's placement at risk.

Clear
Client Consent and Declaration: I confirm that the information I have provided is true as of today's date. I give Safe Haven Sussex CIC the authority to contact and share information with housing benefit offices, community services, social workers, medical professionals and anyone else who may be involved in my accommodation and support. I also give Safe Haven Sussex CIC the authority to act on my behalf on housing benefit applications and to speak to the relevant officers concerning any such matters including benefit officers.

Clear
Should be Empty:

	Yes	No	Details
Daily Living Skills
Self-Care
Budgeting
Literacy and Numeracy
Using Computers/IT literacy
Social Support
Seeking education, employment or training

	Was this a Custodial Sentence?	Where was this sentence served?	Dates of Sentence	Further Info
Most recent offence
Previous Offence
Previous Offence
Previous Offence

Referral Form

Referrer Details

Client Information

Address History

Support Requirements

Physical Health

Mental Health

Drugs/Alcohol Use

Safety and Risk Management

Criminal Offences

Declaration

Right to Rent