FIRST APPLICANT
TITLE
SURNAME
FORENAME(S)
DATE OF BIRTH
MARITAL STATUS
Mr
Mrs
Ms
Miss
Dr
Rev
Single
Co-Habiting
Married to other applicant
Married to third party
Separated
Divorced
Widowed
JOINT APPLICANT
TITLE
SURNAME
FORENAME(S)
DATE OF BIRTH
MARITAL STATUS
Mr
Mrs
Ms
Miss
Dr
Rev
HOME ADDRESS
POSTCODE
HOME ADDRESS
POSTCODE
HOME TELEPHONE
HOME TELEPHONE
YEARS
MONTHS
HOW LONG HERE?
YEARS
MONTHS
HOW LONG HERE?
Owner Occupier
Private Tenant
Council/HA Tenant
Employer's Accommodation
Living w/Parents
Living w/Partner
Other
OCCUPANCY
Owner Occupier
Private Tenant
Council/HA Tenant
Employer's Accommodation
Living w/Parents
Living w/Partner
Other
OCCUPANCY
Week
Month
Quarter
Year
RENT/MORTGAGE
PER
Week
Month
Quarter
Year
RENT/MORTGAGE
PER
Single
Co-Habiting
Married to other applicant
Married to third party
Separated
Divorced
Widowed
LANDLORD/
MORTGAGE CO.
LANDLORD/
MORTGAGE CO.
RENT/MORTGAGE ARREARS
CURRENT
HIGHEST, LAST 12 MONTHS
RENT/MORTGAGE ARREARS
CURRENT
HIGHEST, LAST 12 MONTHS
PRIOR ADDRESS
POSTCODE
PRIOR ADDRESS
POSTCODE
YEARS
MONTHS
HOW LONG HERE?
YEARS
MONTHS
HOW LONG HERE?
Owner Occupier
Private Tenant
Council/HA Tenant
Employer's Accommodation
Living w/Parents
Living w/Partner
Other
OCCUPANCY
Owner Occupier
Private Tenant
Council/HA Tenant
Employer's Accommodation
Living w/Parents
Living w/Partner
Other
OCCUPANCY
EMPLOYMENT
Employed (PAYE)
Employed (Temporary)
Employed (Contract)
Self-Employed (Accounts)
Self-Employed (No Accounts)
Housewife/Househusband
Independent Means
Unemployed
Disabled
Student
Retired
Other
EMPLOYER NAME
EMPLOYMENT
Employed (PAYE)
Employed (Temporary)
Employed (Contract)
Self-Employed (Accounts)
Self-Employed (No Accounts)
Housewife/Househusband
Independent Means
Unemployed
Disabled
Student
Retired
Other
EMPLOYER NAME
WORK TELEPHONE
WORK TELEPHONE
YEARS
MONTHS
HOW LONG HERE?
YEARS
MONTHS
HOW LONG HERE?
MOBILE PHONE
MOBILE PHONE
ANNUAL INCOME
ANNUAL INCOME
Week
Month
Quarter
Year
TAKE HOME PAY
PER
Week
Month
Quarter
Year
TAKE HOME PAY
PER
DO YOU HAVE ANY ADVERSE CREDIT HISTORY?
(eg CCJs, defaults, IVA, bankruptcy)
DO YOU HAVE ANY ADVERSE CREDIT HISTORY?
(eg CCJs, defaults, IVA, bankruptcy)
IF NO, SKIP NEXT SECTION AND GO STRAIGHT TO PROPERTY DETAILS
IF NO, SKIP NEXT SECTION AND GO STRAIGHT TO PROPERTY DETAILS
No
Unsure
Yes
No
Unsure
Yes
EMAIL ADDRESS
EMAIL ADDRESS
REMORTGAGE QUOTATION REQUEST
ALL APPLICATIONS, COMPLETE BLUE SECTIONS. JOINT APPLICATIONS, ALSO COMPLETE PEACH SECTIONS.
AGENCY REF
PLEASE DO NOT CHANGE AGENCY REF FROM NDM3
Yes
No
Yes
No
Yes
No
Yes
No
DETAILS OF ADVERSE CREDIT HISTORY (CCJs, defaults, IVA, bankruptcy, etc)
Default
CCJ
IVA
Bankruptcy
Repossession
Other (Give details)
Default
CCJ
IVA
Bankruptcy
Repossession
Other (Give details)
Default
CCJ
IVA
Bankruptcy
Repossession
Other (Give details)
Default
CCJ
IVA
Bankruptcy
Repossession
Other (Give details)
TYPE
DATE
AMOUNT
PAID?
DATE PAID
DETAILS / EXPLANATION
PLEASE GIVE AS MUCH INFORMATION AS POSSIBLE TO ENABLE OUR UNDERWRITERS TO GIVE YOU A MEANINGFUL QUOTE AND DECISION. IF YOU REQUIRE FURTHER SPACE, PLEASE USE THE 'FURTHER INFORMATION' AREA BELOW.
PROPERTY DETAILS
(PLEASE ANSWER ALL QUESTIONS FOR ACCURATE QUOTE)
PURCHASE PRICE
OUTSTANDING MORTGAGE
DID YOU PURCHASE UNDER A RIGHT-TO-BUY SCHEME?
Yes
No
TYPE OF PROPERTY
TYPE OF TENURE
IF FLAT, HOW MANY FLOORS IN BLOCK?
WHICH FLOOR IS FLAT ON?
Detached House
Semi-Detached House
Terraced House
Maisonette
Flat (Apartment)
Houseboat/Mobile Home
Freehold
Leasehold
Other
IF TENURE IS 'OTHER' PLEASE GIVE DETAILS:
HAS PROPERTY EVER BEEN COUNCIL/ HOUSING ASSOCIATION OWNED?
Yes
No
HAVE YOU TAKEN A SECOND MORTGAGE OR SECURED LOAN ON THE PROPERTY?
Yes
No
IF YOU HAVE FURTHER INFORMATION YOU WISH TO BE TAKEN INTO ACCOUNT, OR YOU NEED MORE ROOM TO ANSWER ANY QUESTION ON THIS FORM, PLEASE USE THIS SPACE.
I/we confirm that the above information is correct and hereby authorise you, your packagers and lenders (1) to use, process and store, by any medium, the information given be me/us in this application, and any other information acquired about me/us during the processing of any application, subject to the provisions of data protection legislation, for the following purposes: a. to obtain credit references from any licensed credit reference agency who may themselves record the search, such information may be used by any lender and others in making credit decisions about me/us or other members of my/our household(s), tracing debtors and controlling fraud. b. for the information requirements of lenders , insurers and advisors. c. to offer products or services to me/us which meet my requirements, or are believed may be of interest to me/us unless I/we tell you not to in writing. (2) to make any enquiries you deem necessary in connection with this and future applications. (3) contact me/us by telephone at home or work, or visit me/us at home to discuss my/our account or application. Please quote me/us for PPP, life cover and other insurances in respect of this application, without charge or obligation. I/we agree to notify you immediately of any material change to the information contained in this application.
FIRST APPLICANT
Please tick box to act as
your signature
JOINT
APPLICANT
Please tick box to act as
your signature
PLEASE DOUBLE CHECK ALL INFORMATION BEFORE CLICKING 'SUBMIT'
IF YES, HOW MUCH IS OUTSTANDING?
CURRENT VALUE
PURCHASE DATE
AMOUNT YOU WISH TO BORROW