Personal Details:

First Applicant:

Title:   Mr. Miss. Dr. Mrs. Ms.                                                                                                                

*  Name:                                  

*  Date of Birth:                         

*  Nationality:                         

*  Telephone No:   

    Mobile No: 

    Email Address:

    Best time to contact:  Daytime Evening Any time    Contact by:  Email only Telephone  

Second Applicant: (If no second applicant please enter n/a in relevant boxes)

   Title:  Mr. Mrs. Ms.

*  Name:                                  

*  Date of Birth:                         

*  Nationality:                         

*  Telephone No:   

    Mobile No: 

    Email Address: 

 Employment Details:

First Applicant:

Status:  Employed Self Employed Retired Other

Since when? 

Net Monthly Income: 

Can you prove your income?:    Yes       No

Second Applicant:

Status:  Employed Self Employed Retired Other

Since when? 

Net Monthly Income:

Can you prove your income?:    Yes       No

Monthly Commitments:

Please enter any monthly repayments you are making

First Applicant:

Mortgage/Rent: 

Loans:               

Other:               

Second Applicant:

Mortgage/Rent:  

Loans:               

Other:               

Credit History:

Have you ever made any late payments on you mortgage or rent, loans, credit cards, or any other credit agreement?     Yes     No

Have you ever had a default or late payment?   Yes       No

Have you ever been declared bankrupt or enter into an IVA?  Yes    No

Property Details:

Have you found a property?     Yes     No

If yes - what is the purchase price/current value? 

Are you re-mortgaging?     Yes     No

How much would you like to borrow? 

Additional Details:

Please use the space below if you wish to add any additional comments:

Completion of this form does not constitute a formal application to a lender.  Please note no credit check will be made at this stage.

PLEASE NOTE: YOUR HOME MAY BE REPOSSESSED IF YOU DO NOT KEEP UP REPAYMENTS ON YOUR MORTGAGE.  FLUCTUATIONS IN THE EXCHANGE RATE MAY INCREASE THE STERLING EQUIVALENT OF YOUR DEBT