Please
Complete the form below as accurately as possible
THE
LOAN
Type
of Loan Required:
Secured Loan
Unsecured Loan
Loan
amount required:
Loan
Term (months):
Purpose
of loan:
PERSONAL
DETAILS
Status:
Married
Single
Divorced
Widowed
Separated
Title:
First
name(s):
Surname:
Date
of birth:
Partner's
first name(s):
Surname:
Date
of birth:
Your
address:
Post
Code:
Time
at this address (Years):
Telephone
(including STD):
Your
Email Address:
Previous
address if you have lived for less than three years at
your current address
PAYMENT
PROTECTION
I/We
would like my/our loan covered by Life Insurance, Accident,
Sickness and also Redundancy Cover. (If self-employed
an equivalent alternative package is available.)
Please
indicate level of cover required
Double Cover
Single Cover
No Cover
Where
I/We have opted not to have a Protected Payment Plan,
I/We understand that it is my/our responsibility to keep
up the payments if I/We am/are unable to work.
YOUR
WORK
(Note:
if you are self-employed please state occupation and how
long trading.)
Employer's
name:
Time
employed by them (Years):
Occupation:
Partner's
employer's name:
Time
employed by them (Years):
ABOUT
YOUR HOME
Total
monthly mortgage payment:
Approximate
amount outstanding:
Total
arrears (if any):
Highest
arrears in the last 12 months (if any)
Original
amount borrowed on mortgage (including all further advances)
The
name of the company you have your mortgage with
Address
of office dealt with:
Mortgage
account number:
The
name of the Bank or Building Society you use
Name:
Account
open (Years):
Current
Account No:
Sort
Code:
Is
you home a:
Flat
Maisonette
House
Bungalow
Is
it:
Terraced
Semi-Detached
Detached
Number
of bedrooms:
Number
of reception rooms:
Year
bought:
What
is it worth now?
The
amount you paid for your home
Is
it owned by:
Self
With your partner
YOUR
INCOME
Your
gross income with overtime and any bonuses (if self-employed
your net income).
Gross:
Per:
Week
Month
Year
Your
partner's gross income with overtime etc.
Gross:
Per:
Week
Month
Year
If
self-employed can you supply accounts?
