Referral form
Referring officer:
Client name:
iWorld or Locata reference (if applicable):
National Insurance number:
Age and date of birth:
Address:
Contact details (phone and email):
Household composition (single, couple, children, other, gender and ages):
Income (for example wages, Universal Credit or other benefits):
Benefit capped? (Yes or No):
Affordability check done? What were the results?:
Preferred area (Willing to move outside of London?):
Landlord contact details (if applicable):
Issues to note (for example medical issues, rent arrears, drugs, ASB, language difficulties):