Broker Enquiry Form

Loan Details

Basic details about the loan being requested.

Loan Amount *

£

Preferred Term *

Purpose of Loan *

Applicant 1 — Personal Details

Primary applicant information.

Title

Full Name *

Date of Birth

Marital Status

No. of Dependents

Age of Dependents

Phone

Email

Current Address

Address

Postcode

Move In Date

Previous Address (if less than 3 years at current)

Previous Address

Previous Postcode

Data Consent

Yes — applicant has given consent

Not yet obtained

Applicant 2 — Personal Details

Complete if there is a second applicant. Leave blank if not applicable.

Title

Full Name

Date of Birth

Marital Status

No. of Dependents

Age of Dependents

Phone

Email

Current Address

Postcode

Move In Date

Previous Address (if less than 3 yrs)

Previous Postcode

Applicant 1 — Source of Income

Select employment type and complete the relevant fields.

Employment Status

Employed

Self-Employed

Retired

Other

Applicant 2 — Source of Income

Complete if there is a second applicant.

Employment Status

Employed

Self-Employed

Retired

Other

Property Details

Details about the security property.

Security Address (if different from current address)

Postcode

Estimated Market Value

Purchase Price

Property Type

Freehold / Leasehold / Feudal

Standard Construction?

Yes

No

Ex-Local Authority?

Yes

No

Owner Occupied?

Yes

No

Any Structural Changes?

Yes

No

Property Specifics

# Bedrooms

# Reception

# Bathrooms

# Garages

# Solar Panels

Floor #

No. of Floors

Years Left on Lease

Existing Mortgage Information

Details of any existing mortgage on the security property.

Lender's Name

Mortgage Account No.

Outstanding Balance

Monthly Repayment

Interest Rate (if known)

Fixed / Variable

Fixed

Variable

Time with Lender

Any Arrears in last 12 months?

Yes

No

Permission to Contact Lender?

Yes

No

Introducing Broker Details

Your details as the introducing broker.

Introducing Broker / Company *

Broker Phone *

Broker Email *

Declaration

Please confirm the following before submitting.

Think carefully before securing other debts against your home. Your home may be repossessed if you do not keep up repayments on your mortgage.

I confirm the information provided is accurate to the best of my knowledge. The applicant(s) have given consent for their data to be processed in connection with this enquiry.

Enquiry Submitted!