Fields marked with a * are mandatory.
 
LOAN DETAILS
Purpose of Loan *
Amount
£
*
Repayment Term *
Protected Payment Plan  Single Cover
 Joint Cover
 No Cover
Where did you hear about us? *
   
PERSONAL DETAILS
1st Applicant  
Surname *
Full Forenames *
Title *
D.O.B (dd-mm-yy) *
   
2nd Applicant  
Surname
Full Forenames
Title
D.O.B (dd-mm-yy)
   
CONTACT DETAILS
Address *
 
Town *
County
Post Code *
Daytime Tel. No.
Evening Tel. No. *
Email Address
Can we use this Email Address to contact you by? Tick for Yes
   
EMPLOYMENT AND INCOME
1st Applicant  
Occupation
Total Monthly Income
£
   
2nd Applicant  
Occupation
Total Monthly Income
£
   
PROPERTY DETAILS
Type of property  House     Bungalow   
 Flat/Maisonette
Is the property leasehold?    
If Yes, unexpired term of lease in years years
Do you occupy the property?    
Does anyone else occupy the property?    
If yes, please give details
Date of purchase
Purchase price
£
Please give details and costings of any significant improvements
Value of property today
£
*
Was the property purchased from the council/housing association?    
Council Valuation
£
Discount Given
£
Discounted Purchase Price
£
   
EXISTING MORTGAGE DETAILS
Lenders Name
Account No.
Total Balance Outstanding
£
*
Total Monthly Payment
£
*
Has your account been in arrears in the past 12 months?    
If Yes, what are the present arrears?
£
and Maximum arrears in 12 months
£
If you have had arrears during the past 12 months, you may be asked to supply further information.
Do you have a secured loan on the property?    
If Yes, you may be asked to provide further information.
   
DATA PROTECTION AGREEMENT
Before we can process your Application, under the terms of the Data Protection Agreement, you must agree to the following conditions:

I hereby confirm that I have Read and Agreed to the above Statement and accept the conditions contained therein.


how much do you want to borrow?
over how long would you like the loan?
 
Your monthly repayment
will be -
Please note this is NOT an offer of a loan. The monthly payment shown above is for illustration purposes only and is subject to status. Your actual rate will depend on individual circumstances.
  THINK CAREFULLY BEFORE SECURING OTHER DEBTS AGAINST YOUR HOME. YOUR HOME MAY BE REPOSSESSED IF YOU DO NOT KEEP UP REPAYMENTS ON YOUR LOAN.