A broker may recommend a remortgage in preference to a secured loan. Untick if you don't want to consider this option:

Date of birth: (dd/mm/yyyy)

Employment status:

Loan amount required:(*)

Term of loan required (months):

Joint or single enquiry

Joint
Single

1st enquirer gross annual income (£) (before tax):

2nd enquirer gross annual income (£):
(if applicable)

Approx. value of property:
(You must own property to enquire)

Approx. mortgage outstanding:
(if applicable)

Who is your current mortgage lender?

Approx. date current property bought: (dd/mm/yyyy)

Approx. amount paid for current property:

Approx total of other loans:
(include credit/store cards etc)

Do you have any credit problems:

No Yes

What Credit problems do you have:
(if applicable}

None
CCJ
IVA
Defaults
Arrears
Bankruptcy
Late/missed loan payments
More than one or other‚ please record below

Permission to perform a credit check?

Brief details of credit issues or any comments you feel may affect your enquiry

Title:

First Name:

Last Name:

Address:

Postcode:

Please note it is not always possible to process enquiries based solely on the information contained in this form. Each case is unique and it may be necessary to speak to you to be able to assess your own particular circumstances to help find the most appropriate course of action. Please supply at least one phone number.

Home phone:

Work phone:

Mobile:

When can you be contacted?

 Daytime  Evening  Weekend

Email address:

Terms and Privacy

Think carefully before securing other debts against your home. Your home may be repossessed if you do not keep up repayments on your mortgage.