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* Essential information
Amount required:*	£
Term:*	years
Purpose of loan:*
Personal Details
Full names (1st Applicant):*
Date of birth (dd-mm-yyyy):*
Are you:	Married Single Divorced Widowed Separated
Full names (2nd Applicant):
Date of birth (dd/mm/yyyy):

Your Address
House No:*
Street:*
Town:*
City:*
Postcode:*
How long have you been in the property:	years

Home phone no. (Inc. STD):*
Mobile:
Email: *

Previous address (ONLY COMPLETE IF MOVED LESS THAN 3 YEARS AGO)
House no
Street:
Town:
City:
Postcode:
How long had you been in your previous house?	years


Employment Applicants (see below if self employed)

1st named applicant Gross monthly income: *	£
Occupation:*
Employers name:*
Time with present employer:	years, months

2nd named applicant gross monthly income:	£
Occupation:
Employers name:

Time with present employer:	years, months

Self Employed Applicants

Occupation:
Net profit:	£
Self cert. of income:	Yes No
Period of self employment:	years, months.

Outgoings

First mortgage:- Current balance for all accounts:*	£
Monthly repayment:*	£
Current arrears:*	£
Highest arrears in last 12 months:	£

Name of your mortgage company:*

Any other secured loans:- Current balance:	£
Monthly repayment:	£
Current arrears:	£
Highest arrears in the last 12 months:	£
Name of lender:

Property

Type of property*	House Flat
	Bungalow Terraced Semi Detached
No. of floor (only if property is a flat)
Type of construction	Concrete Brick Wood
No of bedrooms:
No of bathrooms:
Garage:	Yes No
Is the property:	Freehold LeaseHold
Joint owned?	Yes No
Year built
Is any part of the property to let?	Yes No
Date of purchase:
How much did you pay?	£
What is it worth now?*
Is the property ex-council:
Do you have any valuation reports:	Yes No
Did you purchase from the council:
Council discount (if any)	£