I would like a loan of £

I own my home I do not own my home which is worth £

I am employed I am professionally self-employed I am self-employed I am Unemployed as a

My mortgage is a Repayment Endowment Pension ISA No mortgage Part/part . The outstanding balance is £

I have held a mortgage for 0-5 months 6-12 months 13-24 months 25 months +

My home was Purchased privately Purchased from the Council 3 years ago or more Purchased from the Council less than 3 years ago

I confirm that To my knowledge my credit history is good (no arrears, defaults, or CCJ's) I may have some mortgage arrears, defaults or CCJ's

Applicants

Contact details

Phone: (day) (evening)

Mobile: E-mail:

Post code: House number:

Please call me ASAP 9am-5pm Daytime Evening until 9pm Weekends am Weekends pm

All your information will be treated in confidence and will be used only for providing a quotation.

Declaration

By submitting this application form:

I/we confirm that the information given in this application is true and accurate.
I/we agree that you as a broker provide details of this application to any lending company.
I/we agree that to progress the application further the relevant Loan company may need to contact us for further information.
I/we understand that any selected insurance cover may vary from Lender to Lender and I/we will receive the appropriate details together with the formal offer.
I/we agree that you or any lender you submit this application to may ask any third party to verify the information given.