TITLE
SURNAME
FORENAME(S)
DATE OF BIRTH
MARITAL STATUS
Mr
Mrs
Ms
Miss
Dr
Rev
Single
Co-Habiting
Married
Separated
Divorced
Widowed
EMAIL ADDRESS
DEPENDENTS
(No. of Children under 18)
HOME ADDRESS
POSTCODE
HOME TELEPHONE
YEARS
MONTHS
HOW LONG HERE?
PRIOR ADDRESS
POSTCODE
YEARS
MONTHS
HOW LONG HERE?
MOBILE PHONE
TOWN
TOWN
EMPLOYER NAME
WORK TELEPHONE
YEARS
MONTHS
HOW LONG HERE?
TAKE HOME PAY
PER MONTH
OCCUPATION
WORK ADDRESS
POSTCODE
FULL NAME
DATE OF BIRTH
PRIOR EMPLOYER
YEARS
MONTHS
HOW LONG HERE?
OCCUPATION
WORK ADDRESS
POSTCODE
EMPLOYER NAME
WORK TELEPHONE
YEARS
MONTHS
HOW LONG HERE?
TAKE HOME PAY
PER MONTH
OCCUPATION
WORK ADDRESS
OCCUPANCY
Private Tenant
Live with Parents
Council Tenant
Employer
Housing Association
ARE RENT PAYMENTS
UP TO DATE?
Yes
No
NAME OF BANK
SORT CODE
ACCOUNT NUMBER
NAME ON ACCOUNT
YEARS
MONTHS
HOW LONG HERE?
RENT
PER MONTH
COUNCIL TAX
PER MONTH
HOUSEHOLD BILLS
PER MONTH
WORK/TRAVEL EXP
PER MONTH
YOUR MONTHLY EXPENDITURE
FINANCIAL INFORMATION
EMPLOYMENT INFORMATION
PERSONAL INFORMATION
ABOUT APPLICANT'S PARTNER
ANY ADVERSE CREDIT HISTORY?
Yes
No
HOW MANY
ALL SATISFIED?
CCJs
Defaults
Arrears
Yes
No
Yes
No
Yes
No
eg SW1
eg 1AA
TENANT LOAN QUOTATION REQUEST
ALL APPLICATIONS, COMPLETE BLUE SECTIONS. JOINT APPLICATIONS, ALSO COMPLETE PEACH SECTIONS.
AGENCY REF
PLEASE DO NOT CHANGE AGENCY REF FROM NDM3
CREDIT AND STORE CARDS
DESCRIPTION / CARD ISSUER
CREDIT LIMIT
BALANCE
Yes
No
INTEND TO SETTLE FROM THIS LOAN?
Yes
No
Yes
No
Yes
No
ARE ALL PAYMENTS UP TO DATE?
Yes
No
EXISTING LOANS
NAME OF LENDER
REPAYMENT
BALANCE
Yes
No
INTEND TO SETTLE FROM THIS LOAN?
Yes
No
Yes
No
Yes
No
ARE ALL PAYMENTS UP TO DATE?
Yes
No
LOAN REQUIREMENTS
HOW MUCH TO BORROW?
PREFERRED TERM OF THE LOAN (years)
PURPOSE OF THE LOAN
REQUIRE PAYMENT PROTECTION?
500
750
1000
1250
1500
1750
2000
2250
2500
2750
3000
1
2
3
Car Purchase
Home Improvements
Car & Home Improvements
Furniture
Other
Client Declares: 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.
PLEASE TICK THIS BOX TO ACT AS CLIENT'S SIGNATURE IN AGREEMENT TO DECLARATION
PLEASE DOUBLE CHECK ALL INFORMATION BEFORE CLICKING 'SUBMIT'