Intermediary Details
Company Name
Contact Name
FSA: are you


Network
FSA Number (if applicable/available)
Telephone
Fax
Mobile
Email
   
Enquiry Details
Mortgage Purpose
Estimated Value
Existing Property Sale Price / Valuation
Required Repayment method
Repayment Strategy
Number of Applicants
Amount Required
Are any of the applicants borrowing or receiving assistance towards the balance of the purchase price?
Term required (years)
Non-conforming?
Other
Product Type Required
Initial Duration
Property Details
Tenure
Years Remaining on Lease (if applicable)
Was the property originally purchased under a Right To Buy scheme?
If yes, please enter the RTB discount (£)
Is this a shared ownership mortgage enquiry?
What type is the property?
Is the property ex-Local Authority?
Is this a new build?
Age of property (years)
Is the property of standard construction
Construction Type
If "Other", please specify:
Applicant Details
Title
Surname
Forename
Previous Names
DOB
Relationship to other Applicant(s)
Marital status
Other
Nationality
Any dependents
If so, how many?
Ages of dependents
Address History
Address
Address1
Address2
Town
County
Postcode
Time at this address
 Years  Mths
 Years  Mths
Residential Status
If Other, please explain
Income and Employment
Current Employment Status
Type of employment?
Income, salary or net profit only
Employment History
Employment
Occupation
Company/Trading name
Start Date
Adverse Credit
Has any applicant ever been refused a mortgage on the property to be mortgaged, or on any other property in the last 12 months?
Is any applicant currently in, or has been in, a Debt Management Programme within the last 3 years?
CCJs/Defaults
Applicant Category Date Registered Amount Date Satisfied Will be cleared
Arrears
Applicant Date Registered Missed Amount Date of Clearance Will be cleared
Repossessions
Applicant Date of Repossession Still Outstanding
Debt Management
Applicant Date Registered Amount Date Satisfied Will be cleared
Bankruptcies
Applicant Amount Date of Discharge
IVA
Applicant Date Satisfied Current Years Maintained
Outgoings
Applicant Type Lender Balance Monthly Payment Will be Cleared
Notes
Please give any other information that is relevant to the application