Your
Loan Requirement
Purpose
Of Loan
Please Select
Debt Consolidation
Consolidation and Other
Home Improvements
Holiday
Car Loan
Boat Loan
Caravan Loan
Motorbike Loan
Deposit for House
Deposit for Other
Business Purposes
Cosmetic Surgery
Christmas Cash
Wedding
Funeral
Debt Management
With DM Company
Other
Loan
Amount
£
Your Personal Details
First
Applicant
Second
Applicant (If Applicable)
UK
Resident
Yes/No
Yes
No
Are you on the Electoral Role?
Yes/No
Yes
No
Yes/No
Yes
No
Title
Please Select
Mr
Mrs
Miss
Ms
Dr
Prof
Rev
Pte
Cpl
Sgt
Major
LCpl
Please Select
Mr
Mrs
Miss
Ms
Dr
Prof
Rev
Pte
Cpl
Sgt
Major
LCpl
First
Name
Middle
Name
Surname
Date
of Birth
Day
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Status
Please Select
Single
Cohabiting
Married
Divorced
Widowed
Separated
Please Select
Single
Cohabiting
Married
Divorced
Widowed
Separated
Gross
Income(pa)
Employment
Please Select
Professional/Senior Management
Middle Management
Educational/Medical Services
Office/Clerical
Shopworker
Craftsman/Tradesman
Manual/Factory
Sales Executive
Public Service
Self Employed
House Person
Retired
Management
IT
Student
Looking for Work
Long Term Sick
Bank Worker
Insurance Broker
Journalist
Forces
Legal Profession
Driving Career
Catering
Financial Sector
Labourer
Accountancy
sales Assistant
Cleaner
Carer
Engineer/Mechanic
Painter & decorator
Data Entry Clerk
Emergency Services
Call Centre Agent
Other
Please Select
Professional/Senior Management
Middle Management
Educational/Medical Services
Office/Clerical
Shopworker
Craftsman/Tradesman
Manual/Factory
Sales Executive
Public Service
Self Employed
House Person
Retired
Management
IT
Student
Looking for Work
Long Term Sick
Bank Worker
Insurance Broker
Journalist
Forces
Legal Profession
Driving Career
Catering
Financial Sector
Labourer
Accountancy
sales Assistant
Cleaner
Carer
Engineer/Mechanic
Painter & decorator
Data Entry Clerk
Emergency Services
Call Centre Agent
Other
If Self Employed Fill in The Section Below....
Occupation
Business
Title
Business
Address
(If different from below)
Postcode
Net
Profit (£)
Chartered
Accounts
Yes
No
Period
of Self Employment
Years
Months
Self
Cert. of Income
Yes
No
Time
at Current Address
Years
Months
Years
Months
Your
House & Contact Details
Current
Address
Old
Address (If less than 3 years at Current Address)
Home
Address
(Contd.)
Town/City
County
Post
Code
Home
Phone
Work
Phone
Mobile
E-mail
Property
Details
Number
of Bedrooms
Please Select
1
2
3
4
5
6
More Than 6
Number
of Floors
Please Select
1
2
3
4
More Than 4
Property
Type
Please Select
Semi Detached
Detached
Flat/Apartment
Terraced
End Terraced
Bungalow
Tenure
Please Select
Freehold
Leasehold
Approx
Year Built
Number
of Reception Rooms
Please Select
1
2
3
4
More Than 4
Number
of Bathrooms
Please Select
1
2
3
4
More Than 4
Garage
Please Select
Single
Double
Triple
More Garages
Your
Mortgage Details - For Mortgage Payers & Homeowners Only
Name
of Lender
Please Select
Abbey National
Advance Home Loans
All Types of Mortgages
Alliance & Liecester
Amber Home Loans Ltd.
APS
Bank of Ireland
Bank of Scotland
Barclays Bank
Barnsley Building Society
Bath BS
BDS
Best Advice
Beverley BS
BM Solutions
Bond 2 Let
Bradford and Bingley
Bristol & West
Britannia BS
Britannic Money
Buckinghamshire BS
Burchell Edwards
Cambridge BS
Capital HL/ Irish Permanent
Capital HL/ Irish Permanent
S/C
Chelsea BS
Cheltenham & Cloucester
Chesham BS
Cheshire BS
Chorley & District BS
Clay Cross BS
Clydesdale Bank
Complete MLS
Coventry BS
Darlington BS
Derbyshire BS
Dudley BS
Dunfirmaline BS
Ecology BS
Exclusive Connections
First National
Flagship
Fleet Boston National Bank
Furness BS
Future Mortgages
Gainsborough BS
Genesis
GMAC
Halifax
Hanley Economic BS
Harpenden BS
High Street Home Loans
Hinkley & Rugby BS
HMSL
Holmesdale BS
Home Loan Partnership
ICMG
igroup
IMS
Intelligent Finance
Ipswich BS
Irish Nationwide BS
Irish Permanent
Kensington
Kent Reliance BS
L & G Mortgage Club
Lambeth BS
Leeds & Holbeck BS
Leek United BS
Legal & General Bank
Lloyds TSB Scotland
Loughborough BS
Manchester BS
Mansfield BS
Market Harborough BS
Marsden BS
Melton Mowbray BS
Members Mortgages
Mercantile BS
Monmouthshire BS
Mortgage Express
Mortgage Intelligence
Moirtgage Marketing Centre
Mortgage Master
Mortgage Next
Mortgage Plus
Mortgages Direct
Mortgages Plc
MX-Online
National Counties BS
Nationwide BS
Nat West
Network Mortgages Ltd
Newbury BS
Newcastle BS
New World (Cwlth Bank)
Northern Rock
Norwich & Peterborough
BS
Norwich Union
Nottingham BS
Paragon
Penrith BS
Pink
Platform Home Loans
PMPA
Portman BS
Preferred
Pricipality BS
Private Label
Progressive BS
Royal Bank of Scotland
Saffron Waldon
Scarborough BS
Scot Life
Scottish Amicable
Scottish BS
Scottich Widows Bank
Shepshed BS
Skipton BS
Solent Mortgage Services
SPML
Stafford Railway BS
Stafdfordshire BS
Standard Life Bank
Stoud & Swindon BS
Sun Bank
Swansea BS
The Morgtgage Business
The Morgtgage Operation
The Mortgage Solution Ltd
Tipton & Croseley BS
Trustguard Homeloans
UCB
Ulster Bank
Universal BS
Monthly
Payment
£
Mortgage
Amount
£
Approx.
Property Value
£
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