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Introducer Details

Name:
Email:
Company Name:
Broker address:
Telephone:
Fax:
Comment
If you want to make any comments regarding this case, please use the box below.
This includes information relating to a 'Rate Match'.
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The Loan

Type of Loan Required:
Loan amount required:
Loan Term (months):
Purpose of loan:

Personal details

Status:
Title
First name(s):
Surname:
Date of birth:
Partner's Title
Partner's first name(s):
Surname:
Date of birth:
Your address:
Post Code:
Time at this address (Years):
Telephone (including STD):
Mobile Phone :
Previous address if you have lived for less than three years at your current address
Post Code:

Your work

(Note: if you are self-employed please state occupation and how long trading.)

Employer's name:
Employers address:
Postcode:
Time employed by them (Years):
Job Description:
Occupation Type:
Partner's employer's name:
Partner's employer's address:
Postcode:
Partner's Job Description:
Partner's Occupation Type:
Time employed by them (Years):

About your home

Total monthly mortgage payment:
Approximate amount outstanding:
Total arrears (if any):
Highest arrears in the last 12 months (if any)
Original amount borrowed on mortgage (including all further advances)
The name of the company you have your mortgage with
The name of the Bank or Building Society you use
Account open (Years):
Current Account No:
Sort Code:
Year your home bought:
What is it worth now?
The amount you paid for your home
Is it owned/rented:

Your income

Your gross income with overtime and any bonuses (if self-employed your net income).
Per:
Your partner's gross income with overtime etc.
Per:
If self-employed can you supply accounts? Yes No

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