Applicant 1

Applicant 2

Address

Postal Code

Telephone

Facsimile

Mobile

E-mail

Previous Address
(if less than 3 yrs)

Amount Required

To Be Repaid Over

Purpose Of Loan

Property Value

Date Purchased

Property Type

Outstanding Mortgage

Monthly Repayment

Lender

Ex-Council Property

Discount Received
(if purchased from Council)

Other Secured Loans

Lender

Amount

Any Adverse CCJ's / Defaults ...  (either applicant)

Mortgage Arrears
(in last 12 mths)

Employment Status
Applicant 1

Employment Status
Applicant 2

Earnings Applicant 1

Earnings Applicant 2

Preferred Contact Time

Precise Contact Time

Consent Given To Credit Search