LOAN DETAIL

Loan Amount      

Loan Term  5 years 7 years 10 years 12 years 15 years 20 years 25 years      Loan Purpose 

MAIN APPLICANT

Title  MR MRS MISS DR      First Name        Surname   

Marital Status   Single Married Divorced Separated      Date of Birth     

CONTACT

              Telephone Number              Mobile Number  

If this is a joint application , please fill in the other applicants detail:   

JOINT APPLICANT

Title   N/A MR MRS MISS DR      First Name        Surname  

Marital Status   N/A Married Single Divorced Separated      Date of Birth  

YOUR ADDRESS

House Number        Street  

Town        Post Code  

Time at this address (years)   3 months 6 months 9 months 1 year 2 years 3 years 4 years 5 years over 6 years   

If less than 3 years at your current address, please fill in the details for your previous address:

PREVIOUS ADDRESS

Town        Post Code  

YOUR EMPLOYMENT

Employment   Employed Self Employed Retired Unemployed      Employer`s Name       

Time in this employment   3 months 6 months 9 months 1 year 2 years 3 years 4 years 5 years 6 years over 7 years      Job description   

JOINT APPLICANT EMPLOYMENT

Employment     N/A Employed Self Employed Retired Unemployed        Employer`s Name       

Time in this employment   N/A 3 months 6 months 9 months 1 year 2 years 3 years 4 years 5 years 6 years over 7 years      Job description   

YOUR HOME

Monthly Mortgage payment        Outstanding Mortgage balance  

Arrears Amount (if any)        Total arrears in last 12 months  

Name of company you have your mortgage with  

Current value of your home         Ownership ?   Self With_Joint_Applicant

YOUR INCOME   (if self employed enter net income)

Gross income (including overtime and bonuses)        Paid per   Month Week Year Quarter

JOINT APPLICANT INCOME

Gross income (including overtime and bonuses)        Paid per  Month Week Year Quarter   

SELF EMPLOYED APPLICANTS

If self employed, can you supply accounts ?   N/A - employed NO YES

As set out in our page entitled "Data Protection", by submitting this form you are giving permission for a credit search to be carried out, if necessary

Before submitting, you can click here to print this page for your records