Online Application

This form must be completed in full, incorrect or inaccurate data will delay our response.

All business transacted is subject to our ‘terms of business’

Answer all questions marked *

Broker Details

*Name

Please state Mr/Mrs/Miss/Ms Mr Mrs Miss Ms

*Company

*Address

*Email

*Phone

*How would you like us to proceed with this enquiry?

select Email a quote to me - DO NOT issue documents Email a quote to me & ISSUE documents now Other - Please write comments in notes at end of form

*Please indicate which of the following options you would like to be quoted for:

select Standard terms - variable rate capital and interest Fixed interest - capital and interest repayments Interest only - variable rate interest only

*Marital Status of Applicant

*Resident status of Applicant

*Amount of loan required

*Repayment term required

select 5 Years 6 Years 7 Years 8 Years 9 Years 10 Years 11 Years 12 Years 13 Years 14 Years 15 Years 16 Years 17 Years 18 Years 19 Years 20 Years 21 Years 22 Years 23 Years 24 Years 25 Years

*Purpose of loan

*Full Name

Please state Mr/Mrs/Miss/Ms Mr Mrs Miss Ms

Maiden Name (if applicable)

*Date of Birth (in the following format dd/mm/yyyy)

*Postcode

*Full Address

Previous postcode - if you have been at your current address for less than 3 years.

Previous Address in full:

*Do you have a Home Telephone number (landline):

select Yes No

Home Telephone

Work Telephone

Mobile Telephone

*Email address (IF NONE STATE "NONE")

*Employment Status

select Employed Self Employed with accounts Self Employed no accounts Retired/private pensions Retired/state pensions Unemployed Benefits - please state Other - please state N/A

If other or benefits please specify

*Time with current employer/self employed

Years 0 1 2 3 4 5 6 7 8 9 10+ / Months 0 1 2 3 4 5 6 7 8 9 10 11 12

*Average Gross Annual Earnings (Average Before Tax)

*How long have you held your present bank account?

0 less than 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years 10 years 11 years 12 years 13 years 14 years 15 years 16 years 17 years 18 years 19 years 20 years 21 years 22 years 23 years 24 years 25 years

Have you had any court orders/defaults/debts registered? IVA or Bankruptcy?

select Yes No

If yes, state number of court orders/defaults/debts in last 6 years

select 0 1 2 3 4 5 6

Address of property to be used as security (if different from home address)

*Type of property

select Semi Detached Detached Terraced Flat/maisonette Flat High Rise (5+ Floors) Shop & Flat Business Premises Land Other (please State)

If other please specify

*Approximate value of the property now

*Date you purchased the property

*Price you paid for the property

*Is the property ex-council?

select Yes No

If yes, how much discount was given?

*Who lives in the property?

select Applicant Tenant Vacant Relative Students

*Is the property tenanted?

select Yes No

If yes, state monthly rent received.

*Name of mortgage company

*Approx sum owing on mortgage

*Monthly Mortgage payment

*Has there been any mortgage arrears in the last 12 months?

select Yes No

If Yes, please state the Approximate amount of Arrears owing now?

£

Insurance protection is NOT included with your loan, if you require cover we recommend you seek the services of a professional insurance provider.

Please write in the box below any notes you think may be relevant to your application.
Notes: