Are you or your partner a homeowner/mortgage payer?

Yes No

Date of birth: (dd/mm/yyyy)

Employment status:

Mortgage Details

Minimum mortgage amount needed

Maximum mortgage amount required:(*)

Mortgage term required: (years)

Joint or single enquiry

Joint Single

Have you found a property?

Yes No Remortgage

1st enquirer approximate annual income

2nd enquirer gross annual income

Do you need self-certification of income?

No Yes

Approx. value of property

Current Property (if applicable)

Approximate mortgage outstanding (if applicable)

Approximate date current property was purchased

Price paid for current Property

Credit Status

Approximate total of other loans

Do you have any credit problems:

No Yes

Have you ever had a mortgage application refused elsewhere?:

No Yes

What Credit problems do you have:
(if applicable}

None
Late/missed loan payments
CCJs
IVA
Defaults
Arrears
Bankruptcy
Other‚ please record below

Brief details of credit issues

Other Details

Any comments or questions you think may be useful

Title:

First Name:

Last Name:

Address:

Postcode:

Please note it is not always possible to process enquiries based solely on the information contained in this form. Each case is unique and it may be necessary to speak to you to be able to assess your own particular circumstances to help find the most appropriate course of action. Please supply at least one phone number.

Home phone:

Work phone:

Mobile:

When can you be contacted?

 Daytime  Evening  Weekend

Email address:

Terms and Privacy

Think carefully before securing other debts against your home. Your home may be repossessed if you do not keep up repayments on your mortgage.