Are you/your partner a homeowner/mortgage payer?

Yes No

Current mortgage lender?

Other lender, if not listed above

Any redemption penalties?

No Yes Not sure

Joint or Single Enquiry

Joint Single

1st enquirer's date of birth

Employment

1st enquirer's income (before tax)

2nd enquirer's date of birth

2nd enquirer's employment

2nd enquirer's income

Do you need self-certification of income?

No Yes

Could you (or joint enquirer) have a problem proving income?

No Yes

Do you need to raise extra money?

Minimum mortgage amount required

Maximum mortgage amount required(*)

Approx. value of your property (if applicable)

Original cost of property

Date property purchased

Approx mortgage outstanding (if applicable)

Approx. value of secured loan(s)

Who is your secured loan lender

Other secured lender, if not listed above

Approx total other loans

Reason for remortgaging

Other reason for remortgaging (if applicable)

Please list any other reasons for mortgage

What problems are you having finding a remortgage?

Have you had a mortgage refused elsewhere?:

No Yes

Please read carefully: If you suspect that you currently have a less than perfect credit history or suspect you have EVER had any credit problems whatsoever, please tick. Before a lender provides you with a mortgage they will ALWAYS perform a credit check and will discover your actual credit history. Not declaring it at this stage may count against you.

None
CCJ
IVA
Defaults
Arrears
Bankruptcy
Late/missed loan payments
More than 1 or other‚ please record below

Any questions, comments or brief details of any credit issues (eg arrears, IVAs, defaults,CCJs)

Would you like an assessment of your life insurance payments? (you are probably paying too much):

Yes No

Can a credit check be performed?

Yes No

Title:

First Name:

Last Name:

Address:

Postcode:

Please supply at least one phone number as it is not always possible to process enquiries based solely on the information contained in this form. Each case is unique so it will be necessary to speak to you to be able to assess your needs.

Home phone:

Work phone:

Mobile:

When can you be contacted?

 Daytime  Evening  Weekend

Email address:

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