Confidential Loan Application Form

Tick Checkbox for Joint Policy

personal DETAILS

1st applicant Title Mr Mrs Miss Ms Dr First Name Surname Marital Status Please select Married Single Divorced Widowed Separated Cohabiting Date of Birth (dd/mm/yyyy) Smoker? yes no On Electoral Roll? yes no Are you a UK Resident yes no Number of Dependants

2nd applicant Title Mr Mrs Miss Ms Dr First Name Surname Marital Status Please select Married Single Divorced Widowed Separated Cohabiting Date of Birth (dd/mm/yyyy) Smoker? yes no On Electoral Roll? yes no Relationship to first applicant Please Select Husband Wife Partner Other If other, please specify

Contact details
Best phone contact number
Best time to call	9 - 12 a.m.	12 - 5 p.m.	5 - 9 p.m
E-mail address
Address
Postcode
Previous address if less than 3 years at the above
Address
Postcode

your employment details

1st applicant Self Employed? yes no National Insurance Number Employer's Name How long have you worked there? Employer's Address Your Occupation Type of Employment Please Select Full Time Part Time Agency Temp

2nd applicant Self Employed? yes no National Insurance Number Employer's Name How long have you worked there? Employer's Address Your Occupation Type of Employment Please Select Full Time Part Time Agency Temp

your income
If self employed, can you supply a letter from your accountant confirming income? Please Select Yes No				How many years?
If yes,	Accountant's Name
	Accountant's Address
	Accountant's Tel. No.
Your gross annual income with overtime & bonus (if self employed net pre tax profit)			£
Partner's gross income with overtime & bonus (if self employed net pre tax profit)			£

your current outgoings
Approx. Amount Outstanding Total Monthly Payments Total Arrears (if any) Mortgage (including any further advances) £ £ £ Second Mortgage / Secured Loan (if applicable) £ £ £
Full Name of 1st Mortgage Lender				Mortgage A/c No.
Highest Mortgage Arrears in last 12 months			(if any)	When did it occur?
Full Name of 2nd Mortgage Lender				Mortgage A/c No.
Highest Mortgage Arrears in last 12 months			(if any)	When did it occur?
If the house was purchased or re-mortgaged within the last year, please provide, name, address and mortgage account number of previous lender
Name Account No Address Total monthly repayments for other loans, hire purchase, credit cards etc. £

YOUR LOAN DETAILS
	Do you own a property?	yes	no
Amount Required	£	Term (years)	Please Select 5 years 10 years 15 years 20 years 25 years 30 years 35 years 40 years
Purpose of loan	Please Select Debt Consolidation Home Improvement Car School Fees Holiday Wedding Other	If other, please specify
Address of the property offered as security		Same as that in contact details section
Postcode

credit history
Do you or your partner have any challenges to overcome?	Please Select None Defaults CCJs Been declared bankrupt Fallen into arrears on a mortgage

comments / additional information

Please tick this box if you are a Broker / Solicitor / Introducer
Full Name * Tel. No. E-mail