Mortgage Application Form - 1 of 12
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This Online Mortgage Application form will update and save your information between every page. You may exit the application at any time and your information entered into the form will still be available upon your return. Up to 6 applications can be processed at any one time.
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A - INTERMEDIARY

Application Ref:
* = Required Field

iMAP Broker ID Number *
(this is usually the same as your case tracking password)


Click here if you have forgotten your Broker ID Number
Contact Name *
Name of Firm *
Address *


Postcode *  
Email Address *
Telephone Number *
Fax Number
Name of Network/Mortgage Club
FSA Registration Number *
Appointed Representative FSA firm reference number
CCL Number
Your reference
Agreement in principle number (if applicable)
PRODUCT DETAILS
Lender *
Product Code
Rate/APR * %    
Initial interest rate term / end date *
Mortgage Type *
Was this a face-to-face application? *
Number of applicants?* 1
Level of advice provided *
Date on which sale took place
Type of transaction *



APPLICATION DETAILS
Fees payable: (as per KFI)
When Pay able?
Refundable?
If yes please provide circumstances:
Broker Fee   £
  
Arrangement Fee   £
  
Application Fee   £
  
Legal Fees   £
  
HLC   £
  
Building Insurance   £
  
Other Fees  £
  
TOTAL  £
     
Please provide details of all other fee(s) payable
Procuration Fees Payable: Please provide the details of all parties who will receive payment
 should this mortgage complete (applicants please note that that these amounts are not
 payable by you):
Name      £ 
Name      £ 
Name      £ 
The Valuation Fee referred to on the previous page incorporates an Administration Fee. Our policy is to refund 100% of the Valuation & Administration Fee if the application is cancelled, for whatever reason, prior to the valuer making the inspection.I-Maps will not refund any of the Valuation & Administration Fee after the fee has been spent, and the valuer has made the inspection.test
Please advise payment route for procuration fee payment    
Is / are the applicant(s) required to purchase any compulsory insurance products through you or your business?    
If Yes, please provide details
Please give details of any material non-cash inducements (other than standard procuration / packaging and / or scheme fees) that you have
included within the KFI
SELF-CERTIFICATION / SELF-DECLARATION OF INCOME
Reason for self-certification
Tick box
Please provide detailed explanation below
Proof of income not readily available
Self-employed / contractor
Earned income from various sources
Investment Income
Where there is a deadline
Other

DATA PROTECTION ACT

Your application will be assessed by the lender using a credit assessment process and by searching the
 files of credit reference agencies who will record this search. Any details provided by you or relating to
 your agreement will be held in the lenders’ computer records, and may be returned after your account
 has been closed.
The lender will disclose details about you and your agreement to credit reference agencies who may
 make them available to subscribing lenders for future credit assessment or fraud prevention. The lender
 may use these details and may disclose them to others for market research and other purposes subject
 to the provisions of the DATA PROTECTION ACT 1998. Under the terms of the Data Protection
 Act, you have the right to obtain a copy of the information held about you on payment of the
 appropriate fee, to know the source of the information, to receive the names of the organisations to
 whom your information will be or has been disclosed, and the purposes for which your information will
 be or has been used. You can also ask for any inaccurate details to be amended.
 


YOUR HOME MAY BE REPOSSESSED IF YOU
DO NOT KEEP UP REPAYMENTS ON YOUR MORTGAGE