Confidential secured loan application form

Confidential secured loan application form

Please complete ALL fields of the form. If any questions do not apply, please put N/A in the relevant boxes. Please note that our loans are for homeowners/mortgage payers residing in England or Wales only and are secured on property. If you need any advice or help filling in this form please call 08450 657595.
Your personal details
Applicant 1	Applicant 2
Title	Title
Full name	Full name
Date of birth	Date of birth
Present address	Present address
Post code	Post code
If you have been living at your current address less than 3 years, please provide your previous addresses in the box below	If you have been living at your current address less than 3 years, please provide your previous addresses in the box below
Landline telephone number	Landline telephone number
Mobile phone number	Mobile phone number
Best time to call	Best time to call
E-mail address	E-mail address
Income and Occupation details
Applicant 1	Applicant 2
Occupation	Occupation
Are you	Are you
Length of time in current employment	Length of time in current employment
Gross income £	Gross income £
Is income provable? Yes No	Is income provable? Yes No
Property details
Date of purchase	Is it your first purchase? Yes No
If it is not your first purchase, when did you finish your last mortgage?
If the property was bought under the Right to Buy scheme please state Purchase price £ Council valuation £
Is the property standard construction? Yes No If No, what is it built of?
If it is a flat, what floor is it? How many floors are in the block?
Is the property ex-council? Yes No
Property purchase price £ Current valuation £
Your mortgage details
Present lender
Present mortgage balance £	Monthly mortgage payment £
Current arrears	Reason for arrears
Loan requirements
Amount required £	Term in years
Purpose of loan	Repayment Interest only
Any additional information

Think carefully before securing other debts against your home. Your home may be repossessed if you do not keep up repayments on a mortgage. By submitting this application you confirm that you have read and accept the Borrowers Declaration and Data Protection statement.