Please complete the following, if you do not wish to complete all details complete name and address and contact numbers, print and then forward to us and a Representative will call you to complete the application form - Fax on 01954 231900 or Call 0845 75 73 724

Loan Amount   Repayment  12 months 24 months 36 months 48 months 60 months 72 months 84 months 96 months 120 months 144 months 180 months 240 months 300 months   Purpose of Loan   Date

Title  Mr Mrs Miss Ms Dr    Surname    First Names    Date of Birth

Title Mr Mrs Miss Ms Dr    Surname    First Names    Date of Birth

Home Tel No   Mobile Tel No   Marital Status   Single Married Co Habit Seperated Divorced Widowed   No of Children under 18 

Address Village Town County Post Code

If less than 3 years at current address please give previous address

Address Village Town County Post Code

Home Owner  Yes No   Tenant Council Housing Assoc Private-Furnished Private-Unfurnished Living with Family Employer Other   Landlord   Rent Weekly Fortnightly Four Weekly Monthly

If a Home Owner please complete the following, if a Tenant please proceed to Employment details

Date of Purchase Purchase Price Council Discount Current Value Year Built

Jointly Owned Yes No Freehold Yes No Leasehold Yes No Years on Lease Construction Brick/Tile Roof Brick/Slate Roof Brick/Thatch Roof Brick/Flat Roof Timber/Tile Roof Timber/Slate Roof Timber/Thatch Roof Timber/Flat Roof Concrete/Tile Roof Concrete/Slate Roof Concrete/Thatch Roof Concrete/Flat Roof Steel Construction

Property Details  End Terrace Mid Terrace Semi-Detached Detached Link Detached Detached Bungalow Semi-Detached Bungalow Q Type Maisonette Ground Floor Flat First Floor Flat Second Floor Flat Third Floor Flat Fourth Floor Flat Fifth + Floor Flat Studio Flat Mews Town House   Bedrooms  1 2 3 4 5 6 7 8 9+ Receptions  1 2 3 4 5 6 7+   Bathrooms  1 2 3 4 5 6+   Garage  Single None Double Treble Four +

Do You Have?  Central Heating  Yes No Gas Fires Other   Double Glazing  Yes No Part Secondary   Building Insurance  Yes No   Lodgers  Yes No

1st Mortgage Co   Mortgage Balance Outstanding   Monthly Mortgage Payment 

2nd Mortgage Co  Mortgage Balance Outstanding  Monthly Mortgage Payment 

If Re-Mortgaged what date    Any missed mortgage payments in last 12 months & when 

Employment Details - First Applicant

Gross Monthly Income    Net Monthly Income    Occupation 

Employers Name  Employers Address

How long    Telephone No    Pay Slip  Computerised Hand written None    Self Employed No Yes Contract

If Self Employed Do you have an Accountant No Yes Do you have Accounts No Yes Are your Accounts  Chartered Certified Yourself

Employment Details - Second Applicant

Gross Monthly Income    Net Monthly Income    Occupation 

Employers Name  Employers Address

How long    Telephone No    Pay Slip  Computerised Hand written None    Self Employed No Yes Contract

If Self Employed  Do you have an Accountant No Yes Do you have Accounts No Yes Are your Accounts  Chartered Certified Yourself

Bank Details

Name of Bankers  Account No  Sort Code  Time With Bank

Do you have any County Court Judgements or Defaults in the last 6 years and if so for what amount/s?

Other information that may be useful to assist us in processing you application

Your Email Address  Loan Type Applied For Secured Unsecured Mortgage Re-Mortgage

Data Protection Act Fair Obtaining Warning

The information you have provided will be used by us for the purpose of assessing your application and will be retained on our system and may be submitted to Lenders who will use it for the same purpose.  The Lenders will search your credit record at one or more of the Licensed Credit Reference Agencies.  They will add details of their search to your credit record, and these may be seen by other organizations which make searches in the future.  The Lenders may contact third parties for example your employer or bank to verify the application details you have provided, should an offer be made.  If you do not qualify for the loan applied for or we believe that another product may be more suitable for you, we may pass your details to other Lenders who may offer you alternative loan products.  The information may also be used by us for the subsequent marketing of loan or related products and services to you.  All information held about you by the credit reference agencies may be linked to records relating to one or more persons, for example, your spouse or partner, and that for this application you may be treated as linked financially and that our lenders will consider any associated record.

In forwarding this application you are confirming that the above information is true and correct and you understand the aforementioned Data Protection Act Fair Obtaining Warning.

YOUR HOME IS AT RISK IF YOU DO NOT KEEP UP REPAYMENTS ON A MORTGAGE OR OTHER LOANS SECURED ON IT.  ALL LOANS ARE SUBJECT TO STATUS.

Signature Applicant 1     Signature Applicant 2

Please print and fax this form to 01954 231900