Purpose of Loan *
Amount £ *
Repayment Term:
Protected Payment Plan:
Where did you hear about us?
Other:
PERSONAL DETAILS
1st Applicant
Surname *
Full Forenames *
Title *
D.O.B (dd-mm-yy) *
2nd Applicant
Surname
Full Forenames
Title
D.O.B (dd-mm-yy)
CONTACT DETAILS
Address *
Town *
County
Post Code *
Daytime Tel. No.
Evening Tel. No. *
Email Address
Can we use this Email Address to contact you by?
EMPLOYMENT AND INCOME
1st Applicant
Occupation
Total Monthly Income £
2nd Applicant
Occupation
Total Monthly Income £
PROPERTY DETAILS
Type of property:
Is the property leasehold?:
If Yes, unexpired term of lease in years
Do you occupy the property?
Does anyone else occupy the property?
If yes, please give details
Date of purchase
Purchase price £
Please give details and costings of any significant improvements
Value of property today £ *
Was the property purchased from the council/housing association?
Council Valuation £
Discount Given £
Discounted Purchase Price £
EXISTING MORTGAGE DETAILS
Lenders Name
Account No.
Total Balance Outstanding £ *
Total Monthly Payment £ *
Has your account been in arrears in the past 12 months?
If Yes, what are the present arrears? £
and Maximum arrears in 12 months £
If you have had arrears during the past 12 months, you may be asked to supply further information.
Do you have a secured loan on the property?
If Yes, you may be asked to provide further information
