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Please
Complete the form below as accurately as possible
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THE
LOAN
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Type
of Loan Required:
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Loan
amount required:
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Loan
Term (months):
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Purpose
of loan:
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PERSONAL
DETAILS
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Status:
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Title:
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First
name(s):
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Surname:
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Date
of birth:
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Partner's
first name(s):
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Surname:
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Date
of birth:
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Your
address:
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Post
Code:
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Time
at this address (Years):
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Telephone
(including STD):
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Your
Email Address:
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Previous
address if you have lived for less than three years
at your current address
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PAYMENT
PROTECTION
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I/We
would like my/our loan covered by Life Insurance,
Accident, Sickness and also Redundancy Cover. (If
self-employed an equivalent alternative package is
available.)
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Please
indicate level of cover required
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Where
I/We have opted not to have a Protected Payment Plan,
I/We understand that it is my/our responsibility to
keep up the payments if I/We am/are unable to work.
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YOUR
WORK
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(Note:
if you are self-employed please state occupation and
how long trading.)
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Employer's
name:
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Time
employed by them (Years):
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Occupation:
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Partner's
employer's name:
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Time
employed by them (Years):
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ABOUT
YOUR HOME
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Total
monthly mortgage payment:
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Approximate
amount outstanding:
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Total
arrears (if any):
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Highest
arrears in the last 12 months (if any)
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Original
amount borrowed on mortgage (including all further
advances)
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The
name of the company you have your mortgage with
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Address
of office dealt with:
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Mortgage
account number:
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The
name of the Bank or Building Society you use
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Name:
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Account
open (Years):
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Current
Account No:
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Sort
Code:
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Is
you home a:
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Is
it:
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Number
of bedrooms:
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Number
of reception rooms:
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Year
bought:
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What
is it worth now?
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The
amount you paid for your home
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Is
it owned by:
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YOUR
INCOME
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Your
gross income with overtime and any bonuses (if self-employed
your net income).
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Gross:
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Per:
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Your
partner's gross income with overtime etc.
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Gross:
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Per:
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If
self-employed can you supply accounts?
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Yes
No
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