Personal Details
Full Name
Previous Name/Date
Date of Birth
Marital Status
Children Name & DOB
Smoker/Non Smoker
Nationality
Contact Numbers:
Home:
Mobile:
Work:
Email Address
Residential Details
Current Address
Time at Current Address
Current Residential Status
Previous Address:
(if less than 3 years at current)
Time at Previous Address
Previous Residential Status
Current Mortgage?
Lender:
Balance:
Payment:
Current Rate:
Remaining Term:
IO or Repayment:
Property Value
To be Sold?
Employment Details
Employed/ Self Employed
Employment Status
Occupation Title
Employers Name and Address
Time with Employer
Gross Basic Salary
Net Monthly Income
Overtime/Bonuses (that are considered and can be proven to be regular)
Retirement Age
Financial Details
Monthly Essential Outgoings:
Mortgage
Rent
Council Tax
Gas
Electricity
Water
Telephone
TV/Satellite/Internet
Maintenance
Food
Car/Travel
Life/General Assurance Prem
School Fees
Living Expenses
Monthly Non-Essential Outgoings:
Gym
Holidays
Entertainment
Other
Accountant Details (Self Employed)
Accountants Name
Firm’s Name
Firm’s Address
Contact Number
Credit Commitments - Loans/ Credit Cards /HP
Type:
Balance:
Monthly Payment:
To be Repaid?
Provider:
Type:
Balance:
Monthly Payment:
To be Repaid?
Provider:
Have you had any previous credit problems, including registered (CCJ)/ Arrears History: Please provide amounts and dates.
Property To Be Mortgaged
Purchase Price/Value of property
Deposit Available
Mortgage Required
Property Address:
House/Flat Etc
Tenure
If Leasehold -
Lease Length
If House -Detached/Semi/Terraced/
If Flat/Maisonette -
Purpose Built/Converted
If Flat/Maisonette –
Floors in block:
Flat on floor
Bedrooms
Receptions
Bathrooms
Garage
Parking
Year Built
Other Properties
Address
Property Value
Mortgage Balance
Monthly Payment
Rent Received
Lender
Address
Property Value
Mortgage Balance
Monthly Payment
Rent Received
Lender
Estate Agent Details (if applicable)
Agent Address:
Agent Phone Number:
Solicitor Details (if applicable)
Name of Person Acting:
Firm Name:
Firm’s Address:
Tel Number:
Mortgage Payment Details
Direct Debit Details:
Sort Code:
Account Holder:
Bank Branch:
Fee Payment Details
Card Type:
Card Number:
Issue Date:
Expire Date:
Security Code:
Protection for your Mortgage, debts etc.
What would happen to this property if you die?
What would happen to this property if you have a critical illness?
What would happen to this property if you are unable to work?
What would be the impact on your partner and/or dependant/s if the property is protected & cleared?
Protection, Savings & Investments
Provider/Holding/ Source: / Current Value: / Reg Contribution: (if applicable) / Projected Value: / Maturity/Due Date: (if applicable)
Pensions
ISA
Endowments:
Stocks & Shares
Bank Accounts:
Inheritance:
Existing Protection: / Provider/Holding/ Source: / Sum Assured: / Type: (LTA, CIC etc.) / Premium: / Term:
Employers Benefits: / Type:(sick pay,death in service,healthcare) / Amount:
Notes:
Declaration:
Please sign below (or tick box if completing electronically to confirm that all the information provided is accurate to the best of your knowledge and you are content to proceed with the application as per our advisers recommendation.
Applicant1: Applicant 2:
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