| About You |
| Your residential status? |
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| Are you a UK Resident? |
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| Do you have UK permanent resident's rights? |
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| Who would you like the cheque made payable to? |
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| Loan Amount £: |
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| Main purpose of loan? |
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| If 'Other', please specify: |
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| Repayment period |
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| Your personal details |
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| Date of Birth? |
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| Your Marital Status |
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| Years with bank? |
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| Children under 18? |
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| Is your property jointly owned? |
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| Your employment details |
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| Your employment status: |
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Proof of Income
(if self-employed)? |
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| Time in current job? |
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| What is your occupation? |
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| Annual Income £: |
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| Is that before or after tax? |
Before
After |
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| Do you receive additional income? |
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| Only complete this section if you receive an additional income. |
| Source? |
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| Amount £: |
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| Your contact details |
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| Title: |
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| First name: |
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| Middle name: |
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| Surname: |
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Your maiden name?
(if applicable) |
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| Address 1: |
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| Address 2: |
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| Town: |
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| Postcode: |
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| County: |
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| Best time to call? |
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| Do you have a landline number? |
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| Phone Number (inc. area code) |
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| Mobile Phone number (mandatory if no land line) |
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| Work Phone number |
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| Email Address |
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| Mother's maiden name? |
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| Your Partner |
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| If you are applying for a loan and you are married or living with a partner, you will need to fill in this section: |
| Is your partner a UK Resident? |
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| Does your partner have UK permanent resident's rights? |
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| Title |
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| First name |
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| Middle name |
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| Surname |
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Your partners maiden name?
(if applicable) |
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| Date of Birth? |
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| Partner's Marital Status |
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| Years with bank |
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| Does your partner have their own landline number? |
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| Phone Number |
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| Mobile Phone number |
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| Work Phone number (if applicable) |
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| Employment Status |
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Proof of Income
(if self-employed)? |
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| Time in current job? |
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| Annual Income (before tax) £ |
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| Does your partner live at the same address as you? |
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| Only complete below if your partner does not live at the same address as you. |
| Partner's address details |
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| Address 1 |
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| Address 2 |
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| Town |
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| Postcode |
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| County |
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| Your Home |
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| Value of your property £ |
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| Approximate year built? |
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| Original purchase price £ |
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| When was it purchased? |
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| How many bedrooms? |
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| What type of property is it? |
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| If “Other” please specify |
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| If you live in a flat/maisonette, how many floors does it have? |
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| What is its construction? |
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| Was your property owned by the council? |
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| Did you purchase as a sitting tenant? |
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| What did the council value the property at for the purchase £ |
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| What discount did you receive from the council £ |
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| Previous address |
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| Have you lived at your current address more than 3 years? |
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| Only complete below if you've lived at your current property for less than 3 years. |
| What was your previous address? |
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| Address 1 |
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| Address 2 |
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| Town |
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| Postcode |
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| County |
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| Your Mortgage |
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| Who is your Mortgage with? |
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| Have you had a previous mortgage? |
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| If Yes, how long have you had a mortgage for? |
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| What is the total balance outstanding on your mortgage £ |
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| Monthly payment £ |
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| What is the term remaining on your Mortgage? |
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| Only fill the months box if it has less than 1 year left to run |
| What type of mortgage do you have? |
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| Have you had arrears on your mortgage in the last 12 months? |
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| What are the present arrears on your mortgage? £ |
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| What is the highest your arrears have been in the last 12 months? £ |
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| Have you made your last 3 repayments on time? |
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| Do you have any other loans secured against the property? |
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| If yes... Which company is this loan with? |
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| What is the total amount you owe this company? £ |
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| I have read and accept all parts of this declaration: |
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