Amount required:

Term:

-- select -- 5 years 7 years 8 years 10 years 12 years 15 years 20 years 25 years         

Purpose of loan:

-- select -- Consolidation Home Improvements Car Other (please state opposite)     

Type of loan :

-- select -- Mortgage Re-Mortgage Secured or Unsecured Loan     

First Applicant:

Second Applicant:

Title:

-- select -- Mr Mrs Ms Miss Dr      

Title:

-- select -- Mr Mrs Ms Miss Dr      

First names:

First names:

Surname:

Surname:

Marital status:

-- select -- Married Single Divorced Cohabiting Separated Widowed Other        

Marital status:

-- select -- Married Single Divorced Cohabiting Separated Widowed Other        

Date of birth:

Date of birth:

If less than three years at current address please give previous address

Address:

Previous address:

Town/City:

-- select -- 0 1 2 3 4 5 6+  yrs  -- select -- 0 1 2 3 4 5 6 7 8 9 10 11   mths

-- select -- House Flat Other    

If other, please give details:

How many floors in total?

Name of first mortgage lender:

-- select -- 0 1 2 3 4 5 6+ yrs -- select -- 0 1 2 3 4 5 6 7 8 9 10 11 mths

Amount outstanding:

Other outstanding finance that will not be cleared from the proposed loan:

-- select -- 0 1 2 3 4 5 6+  yrs  -- select -- 0 1 2 3 4 5 6 7 8 9 10 11   mths

How long employed:

-- select -- 0 1 2 3 4 5 6+ yrs -- select -- 0 1 2 3 4 5 6 7 8 9 10 11 mths

Other income per annum:

Details: