Address: 37 Great Queen Street  ,London  WC2B 5AA

Tel: 02074054690 / 01279 835129  Fax: 01279835129; Mobile: 07754734924








Applicant Details

Client 1

Client 2

Full Name (and previous surname)



Date of Birth



Relationship to other applicant



Marital Status




Dependants (Y or N) if yes ages


Married/single/divorced etc




Married/single/divorced etc




Current Address & Postcode




Date moved into current address?d/mm/yyyy




Current residential Status


If  is tenant,current landlord’s name and address?


Current landlord’s telephone number?


Tenancy reference number?

Date current tenancy started?—dd/mm/yyyy

How is rent paid? –cash/standing order?/direct debit?

Monthly rent amount?

Any arrears in the last 18 months?



























Length of time at current address



Previous address and postcode if less than 3 years. (Detail other addresses on separate page if necessary and include overseas address.)



Length of time at this address



Telephone numbers: home









Category of Applicant: e.g First Time Buyer, Mover, remortgage, Right To Buy, Commercial, Buy To Let






Status: Employed / Contract / Self Employed



Time in current employment (if less than 6 months please provide details of previous employer)



Basic Salary (if non status mortgage required, write ”not applicable”)



Guaranteed Overtime



Regular Bonus



Other income (please specify)



Expected retirement age



If Self Employed, number of years Accounts available.



Name of business if self employed



National Insurance Number






If applicable what type of visa are you on?



When does this expire?



Date current employment started?-dd/mm/yyyy



Employer’s telephone number?



Employer’s name and address?



Income-annual income before tax/regular overtime/guaranteed bonus/guaranteed commission?






Contract for valuation? Name,address and contract telephone number?

Selling agents? Name,company,address and contract telephone number?

Solicitors details?name,company,address and contract telephone number?












Financial Details


Do You have any Credit Cards?

If yes,name of lender/account number



Total amounts outstanding and monthly payments?



Do you repay the full amount each month?






Do you have any loans, HP or rental agreements?



If Yes, name of lender

account number/amount outstanding?



Monthly payment?



Amount Outstanding



Number of Months remaining



Are any of the above amounts to be added to the mortgage?






Have you ever had any CCJ/Defaults registered against you? If so please detail.



Have you ever been declared bankrupt or made arrangement with creditors?



Have you any previous mortgage or rent arrears? If so, please detail.



Who do you currently bank with?



Account number



Sort Code



How long have you held this account



Credit card details to pay the valuation fee:  

The long card number

The issue date

The expiry date

The issue number

The 3 security numbers on the back of the card

The name of the cardholder




Current Mortgage Details


Lender And Account Number



Amount of Loan Outstanding



Years remaining



Repayment method (endowment / repayment etc)



Interest rate if known and monthly cost



Type of interest rate: Fixed, variable etc.



Any penalties to transfer your mortgage, if yes how much. Is the current mortgage portable to a new property?



Value of property




Property to be mortgaged.


Address of the property to be mortgaged and postcode.

Number of bedrooms/bathrooms/living rooms/habitable rooms?

Central heating type-gas/electrict/oil?

Any garages?

Type of property?


Detatchment type?detached/terraced/semi/end terrace/converted/purpose build?

Year property built?





Purchase Price




How much do you want to borrow?




Does this include any fees?




Property Type: Freehold / Leasehold

If leasehold,number of years left on lease/ground rent payable?




Do you have the funds available to complete this transaction?




Source of Funds?




Business Type

How many years the business has been set up?

Weekly turnover

Business Rate

Any accommodation?

who will live there?



If is a leasehold ,how many years lease left?

How much rent per year?

Weekly turnover?

Business rate?







Prime/Sub Prime/BTL/Commercial/Other






Preferred product Type:-e.g. Fixed, Tracker, Discount

Int only/Capital Repayment



Declaration:  I have advised the applicant(s) that a formal credit search may be carried out in their name(s) with Credit Reference Agencies who will record details of the search and may create a financial association with those with whom they are linked financially. The mortgage lender will check their details with a fraud prevention /agencies and if the applicants have given us false or inaccurate information and fraud is suspected, the mortgage lender will record this





Signature :_________________________



Print Name:________________________



Please fill in the form fax to us on 01279 835129 or