Jade Ambrose

SignedNo house

Referred 8 days ago · St Basils · Owner Nadia Karim · 39 Sladefield Road (Reliance)

Referral

Referral source

St Basils

Referrer

Callum Beattie · referrals@stbasils.example.org

Placing authority

Birmingham City Council

Current situation

Family breakdown

Local connection

Yes

Reason for the referral

Nineteen and asked to leave home in Ward End. No income at all and no claim made yet.

Case note

Came in Friday and signed; countersigned the next morning. She is first on the list for the next room at Sladefield Road.

Tenant — identity

7 of 7

Full name

Date of birth

NI number

Gender

Ethnicity

Contact number

Tenant — physical descriptors (SD3)

5 of 5

Skin tone

Hair colour

Eye colour

Height (cm)

Build

Referral (SD2)

4 of 4

Referral agency

Referrer name

Reason for referral

Nineteen and asked to leave home in Ward End. No income at all and no claim made yet.

Referral date

Property

4 of 4

Room address

Building address

Fire assembly point

The front pavement on Sladefield Road, by the gate.

Fire exit locations

Front door onto the hall, and the kitchen door onto the rear yard.

Charges (weekly)

6 of 6

Basic rent

Eligible service charge

Ineligible service charge (total)

Ineligible — utilities

Ineligible — support

Total weekly charge

Max arrears (= 2 × ineligible total)

Staff / provider

2 of 2

Support worker name

Support provider

Dates

1 of 1

Agreement date

Pack

10 sheets

Standard pack · SD1–SD10

SD1 Licence agreementSigned 21 Sep
SD2 Referral, risk & GDPR consentSigned 21 Sep
SD3 Missing person profileSigned 21 Sep
SD4 Confidentiality agreementSigned 21 Sep
SD5 Authorisation to actSigned 21 Sep
SD6 Fire evacuation planSigned 21 Sep
SD7 Fire safety inductionSigned 21 Sep
SD8 Service charge scheduleSigned 21 Sep
SD9 Resident rights & responsibilitiesSigned 21 Sep
SD10 Photo ID consentSigned 21 Sep

Added as a tenant on 21 Sep 2026 — no house yet

Activity

Pack generated
21 Sep 2026
10 sheets generated · added as a tenant
Nadia Karim
Countersigned
21 Sep 2026
Pack reviewed and countersigned · 10 sheets
Nadia Karim
Tenant signed
20 Sep 2026
29 details taken · 10 sheets to generate
Jade Ambrose
Referral received
14 Sep 2026
St Basils · family breakdown
Callum Beattie