Client Details First Applicant Second Applicant
Title
Forename(s)
Surname
Date of Birth
Nationality
Marital Status
Dependants Yes No Ages Yes No Ages
Current Address
Poscode

Poscode
Current residential status
Length of time at current address Yrs Mths Yrs Mths
Telephone Number
Email Address

OCCUPATION DETAILS First Applicant Second Applicant
What is your occupation / job title?
Employment Status - Are you?
Time in current employment Yrs Mths Yrs Mths
Annual Income £ £

Bank Details    
Who do you bank with?

Credit Commitments Total per month Total per month
Monthly payments to credit cards, loans, etc £ £

Credit History    
Have you ever had any credit issues? (missed payments, CCJs, defaults, IVA,etc)
If so, please provide details in the notes below.
Yes No
Yes No

MORTGAGE REQUIRED
First Time buyer Moving Home Remortgage Buy to Let

CURRENT MORTGAGE DETAILS First Applicant Second Applicant
Current Lender/Lenders      
What is the Sale Price/Property Value £ £
Amount of loan outstanding £ £
Repayment method      
Current monthly payment £ £
Interest rate type      

PROPERTY DETAILS  
Address of property to be mortgaged (including postcode):
Property Type:
Tenure: Lease Remaining: Years Construction:
Type:    No of Bedrooms:   Property Age:
 
Purchase Price / Valuation £ 
Amount of deposit available £ Source of deposit    
Total Amount to borrowed £ Purpose of loan if remortgage    
Term     Years Budget £ per month
 
Notes

ATHORITY TO ACT & DECLARATION
Data Protection
I/we consent to the information you hold on me/us being processed and held on computer or paper files. I/we consent to any information that I/we give to be disclosed to third parties and product providers for the purpose of my application. I/we consent to the data being checked and/or disclosed to the regulatory authorities as part of compliance monitoring activities.

Credit Reference Agencies
I/we understand that the information I/we have provided may be disclosed to licensed credit reference agencies which will retain a record of the search. Others may use this in assessing applications from ourselves and other members of our household and for occasional debt tracing and fraud prevention.

Authority to Act
I/We hereby give the mortgage adviser authority to act exclusively on my/our behalf in obtaining a suitable mortgage product from whichever lender they consider most appropriate. I/We confirm that the personal and confidential information provided by me/us can be disclosed by the mortgage adviser for the purposes of arranging a mortgage on my/our behalf.

FUTURE CUSTOMER CONTACT:
We would like to contact you from time to time by telephone to discuss your mortgage arrangements. This will enable us to ensure your mortgage is suitable for you at all times. In order for us to do this, we need to obtain permission from you.

If you do not wish to receive any future relating correspondence or contact for reasons of review or information on new products, please tick this box

Security:

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YOUR HOME MAY BE REPOSSESSED IF YOU DO NOT KEEP UP REPAYMENTS ON YOUR MORTGAGE
OR OTHER DEBTS SECURED ON IT.