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1st Applicant
2nd Applicant
Full Name
Date of Birth
day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Employment
Employed Self-employed Unemployed
Resident In?
UK Non - UK
Annual income
£ (no space / no comma)
Loan details
Loan required
Please Select £5,000 £6,000 £7,000 £8,000 £9,000 £10,000 £11,000 £12,000 £13,000 £14,000 £15,000 £16,000 £17,000 £18,000 £19,000 £20,000 £21,000 £22,000 £23,000 £24,000 £25,000 £26,000 £27,000 £28,000 £29,000 £30,000 £31,000 £32,000 £33,000 £34,000 £35,000 £40,000 £45,000 £50,000 £55,000 £60,000 £60,000 +
Repayment terms
Please Select 3 years 4 years 5 years 6 years 7 years 8 years 9 years 10 years 11 years 12 years 13 years 14 years 15 years 16 years 17 years 18 years 19 years 20 years 21 years 22 years 23 years 24 years 25 years more than 25 years
Loan purpose
Please Select Consolidation Home Improvements Holiday Car Loan Motorbike Loan Debt Consolidation Deposit for House Business Purposes Debt Management Other
Contact details
Primary contact telephone
Secondary contact telephone
Work telephone
Email
Housing details
What is your housing situation ?
Please Select Answer _________________________________ Homeowner - private purchase Homeowner - bought from council (right to buy) Homeowner - bought from housing association _________________________________ Tenant with private landlord Tenant with agency rental Council Tenant MOD Tenant With Parents Housing Executive Tenant Housing Association Tenant Living with Friend
Questions for HOMEOWNERS only
Value of your home ( approx.)
Mortgage balance
Monthly mortgage repayment
Credit history
Do you have poor credit ?
Yes No
Number of mortgage arrears
Number of CCJs / Defaults
Additional information (if any)
I have read and agree with the Data Protection Statement
Your home is at risk if you do not keep up repayment on a mortgage or other loan secured on it.
