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Your residential status? *   Who would you like the cheque made payable to? *
Loan amount? *   Main purpose of the loan?
Loan period *   Current Debt level, if any:*
Do you have adverse credit? (if yes, we can still help)* yes no   Your title
First Name *   Middle Name
Sur Name*   Date of birth? * / /
Address*   Town/City *
Postcode*   County*
Email*      
Phone number *   Mobile number *
Best time to call *   When to call
Property Postcode:*   Property name/ number:
Your Maiden Name   Mothers maiden Name*
Years with your bank?   Children under 18?
Employment status? *   Time in your present job? *  
What is your occupation? *   Annual income before tax? *
Your marital status*   Is property jointly owned? yes no
 
 Your Partner - If you are married or cohabiting
 
If you are applying for a loan and you are married or living with a partner, we will need to ask
questions about your partner
     
Your title   Middle name
First name *   Surname *
Your maiden name *   Date of birth? * / /
Children under 18?   Your marital status?
Home phone (+ area code) *   Mobile phone number*
Email address   Best time to call
Years with your bank?   Time in your present job? *  
Annual income before tax? *   Your employment status?*
Mothers maiden name   Lives at same address? * Yes
No
   
Address
House Number *
Street *
Town/City *
Postcode *  
County
Additional income? * yes no      
If self-employed, what proof
of income do you have *		 Accounts
Tax Returns
Self-certification
 
If so what is this annually? *
Source of this income? *
 
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Who is your present
mortgage company? *		 What is the total balance outstanding on your mortgage *
Monthly repayment? *   What is the term remaining
on your mortgage? *
What type of mortgage do you have? *   Have you had arrears on your
mortgage in the last
12 months? *		 yes no
     
Mandatory if you answered "yes" to the above question:
What are the present arrears on your mortgage? *
What is the highest your arrears have been in the last 12 months? *
Have you made your last 3 repayments on time? * yes no
Do you have any other loans secured against your property? * yes no
If yes, which company was this loan with?
What is the total amount you owe this company?
 
 
Your House
 
The value of
the property    £ *		   Number of bedrooms *
Approximate year built?   When did you purchase it?
(year if month/day unknown) *		 / / /
What was the original purchase price? £   Property type? *
If a flat, how many floors
in the building? 		  What is the construction? *
Has property been owned
by council?		 yes no   Time at current address? * Less than 3 yrs
More than 3 yrs
Ex-council Owners
(only complete this section if property is ex-council)
Did you purchase as sitting tenant? yes no
As you answered "Yes" to the above, please answer the following:
What did the council value the property at for purchase?
What discount did you receive from the council?
If less than 3 years, confirm previous address:
Address line 1 *
Address line 2
Town/City *
County *
Postcode *  
           I ACCEPT  
   
   
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