Intermediary Details
Intermediary Firm
Contact Name
FSA: are you


Network
FSA Number (if applicable/available)
Telephone
Mobile
Email
 
Authority
Please confirm that the applicant has given authority for the intermediary to supply the information requested below to the lender and the release of this information to any other third party connected with this introduction or placement of the transaction.
If you do not wish to write the business yourself, we can provide a referral service where we can contact the client directly and complete the full sales process. Please only check yes below if you wish us to provide this service.
Applicant Details
Type of Applicant
Name of Company
Directors Names (if Ltd Company)
Partner Names (if LLP)
Trade/Business Type
Does the Applicant or related person (spouse, common law partner, parent, sibling, child, grandchild, grandparent) dwell or intend to dwell at part of the property offered as security ?
If Yes, does this part exceed 40% of the total security area ?
Applicant Names
Applicant/Director/Partner 1
Title
First Name
Surname
Date of Birth
Applicant/Director/Partner 2
Title
First Name
Surname
Date of Birth
Applicant/Director/Partner 3
Title
First Name
Surname
Date of Birth
Applicant/Director/Partner 4
Title
First Name
Surname
Date of Birth
Contact Details
Correspondence Address



Postcode
Email
Telephone
Home
Work
Mobile
Financial Information
Income Evidence:
Please tick only one of the boxes and provide corresponding details
1 years accounts
If yes
 Net profit (£)
 Depreciation (£)
 Finance Costs (£)
We will require sight of the accounts to verify the trading reconstituted profits.
Management accounts
Annual Rental Income (£)
Employed Income (£)
Credit Status
Any Existing CCJs
If Yes, number of unsatisfied CCJs in the past 2 years
Value (£)
Any arrears in the last 12 months
If Yes, highest arrears in the past 12 months (remortgages only) (£)
Previous Bankruptcy
If Yes, when was it discharged ?
IVA



CVA



Mortgage Required
Commercial Mortgage Amount Required (£)
Term
Years
Purpose of Loan
Address of Property Offered as Primary Security



Postcode
Brief Description of Property
Tenure of Security -


Years Remaining on Lease (if applicable)
Current Value (£)
Where Property Already Owned -
Date Purchased dd/mm/yyyy
Original Purchase Price (£)
Amount of Outstanding Mortgage/Charge (£)
Name of Lender
Where Property To Be Purchased -
Purchase Price (£)
Please enter the value of the following included in the purchase price.
Fixtures and Fittings (£)
Goodwill (£)
Stock (£)
Investment Property
Lease Start Date dd/mm/yyyy
Current Annual Rent £
Next rent review
Name(s) of tenant(s) if known
Telephone number for tenant(s) if known
Further Information
Please provide any further information relevant to the application including current portfolio and previous experience.