Full Name*

Purpose of loan
(50 words maximum)

Repayment type

Interest only

Repayment

Rate

Fixed

Variable

Gross annual salary

Applicant 1
£

Applicant 2
£

Employment Status

Applicant 1 Employed Self Employed None

Applicant 2 Employed Self Employed None

Years in current job

Applicant 1

Applicant 2

Is income provable

Applicant 1
Yes No

Applicant 2
Yes No

Number of CCJs registered within last 5 years (unsatisfied)

Total value of unsatisfied CCJs

£

Total value of satisfied CCJs

£

Property type

Freehold Leasehold

Date property purchased

dd/mm/yy

Main residence

Yes No

Purchase price

£

Current value

£

Which lender is current mortgage with?

If less than 12 months who was the previous lender?

Monthly payments

£

Outstanding balance

£

Current arrears

£

Highest arrears within last 12 months

£

Do applicants have a current secured loan or second mortgage?

Yes No

If yes amount owed
£

Other outgoings

£ (Endowment etc.)

Title

Mr Mrs Ms Miss Dr

First name

Middle name/s

Surname

Date of birth

dd/mm/yy

Title

Mr Mrs Ms Miss Dr

First name

Middle name/s

Surname

Date of birth

dd/mm/yy