Loan Amount
-Please Select-
£1000
£5000
£7500
£10,000
£12,500
£13,000
£14,000
£15,000
£16,000
£17,000
£18,000
£19,000
£20,000
£25,000
£30,000
£35,000
£40,000
£45,000
£50,000
£55,000
£60,000
£65,000
£70,000
£75,000
Loan Purpose
-Please Select-
Debt Consolidation
Home Improvements
Remortgage
Car
Holiday
Computer or Equipment
Plastic Surgery
Medical Bills
Wedding
Income Tax Bill
Motorhome/Caravan
Motorcycle
Christmas
Pref. Repayment Term
Please Select
60 months/5 years
72 months/6 years
84 months/7 years
96 months/8 years
108 months/9 years
120 months/10 years
132 months/11 years
144 months/12 years
156 months/13 years
168 months/14 years
180 months/15 years
192 months/16 years
204 months/17 years
216 months/18 years
228 months/19 years
240 months/20 years
252 months/21 years
264 months/22 years
276 months/23 years
288 months/24 years
300 months/25 years
Have you ever...
- Had a CCJ or Default registered against you?
Yes
No
- Missed a secured loan or mortgage payment in the last year?
Yes
No
- Been declared bankrupt or had an IVA?
Yes
No
Title
-Select-
Mr.
Mrs.
Miss
First Name
Last Name
Date of Birth
MM
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
DD
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
YY
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
Employment Status
Employed Full Time
Employed Part Time
Self Employed
Retired
Student
Housewife
Househusband
Unemployed
Occupation
Yearly Income (£)
Job Length
-Please Select-
1 Year
2 Years
3 Years
4 Years
5 Years
6 Years
7 Years
8 Years
9 Years
10 Years
11 Years
12 Years
13 Years
14 Years
15 Years
16 Years
17 Years
18 Years
19 Years
20 Years
21 Years
22 Years
23 Years
24 Years
25 Years
26 Years
27 Years
28 Years
29 Years
30 Years
Mother's Maiden Name
Phone Number
No. & Street
Marital Status
-Please Select-
Single
Married
Divorced
Living with Partner
Separated
Widow
Widower
Town/City
Postcode
Number of Children
What is your maiden name?
About your mortgage:
Property Purchase Date
MM
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
DD
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
YY
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
Purchase Price (£)
Current Property Value
Year Built
Property Type
-Please Select-
Detached
Semi Detached
Terraced
Mid Terrace
End of Terrace
Flat
Bungalow - Detached
Bungalow - Semi-Detached
Bungalow - Terraced
Care Home
Maisonette
Chalet/Dormer
Townhouse
Other
Original Mortgage Amount
Time At House
-Please Select-
Less than 3 Years
More than 3 Years
Types of Walls
Please Select
Bricks & mortar
Concrete panels
Concrete poured
Mobile home
Steel framed
Stone
Timber framed
Number of Bedrooms
-Please Select-
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20 +
Previous Address Information:
No. & Street
Town/City
Postcode
Mortgage Outstanding
-Please Select-
£0
£5,000
£6,000
£7,000
£8,000
£9,000
£10,000
£11,000
£12,000
£13,000
£14,000
£15,000
£16,000
£17,000
£18,000
£19,000
£20,000
£25,000
£30,000
£35,000
£40,000
£45,000
£50,000
£55,000
£60,000
£65,000
£70,000
£75,000
£80,000
£90,000
£100,000
£110,000
£120,000
£130,000
£140,000
£150,000
£160,000
£170,000
£180,000
£190,000
£200,000
£210,000
£220,000
£230,000
£240,000
£250,000
£260,000
£270,000
£280,000
£290,000
£300,000
£310,000
£320,000
£330,000
£340,000
£350,000
£360,000
£370,000
£380,000
£390,000
£400,000
£410,000
£420,000
£430,000
£440,000
£450,000
£460,000
£470,000
£480,000
£490,000
£500,000
£510,000
£520,000
£530,000
£540,000
£550,000
£560,000
£570,000
£580,000
£590,000
£600,000
£610,000
£620,000
£630,000
£640,000
£650,000
£660,000
£670,000
£680,000
£690,000
£700,000
£710,000
£720,000
£730,000
£740,000
£750,000
£760,000
£770,000
£780,000
£790,000
£800,000
£810,000
£820,000
£830,000
£840,000
£850,000
£860,000
£870,000
£880,000
£890,000
£900,000
£910,000
£920,000
£930,000
£940,000
£950,000
£960,000
£970,000
£980,000
£990,000
£1,000,000
£1,000,000+
Monthly Payments
-Please Select-
£0
£100
£200
£300
£400
£500
£600
£700
£800
£900
£1,000
£1,100
£1,200
£1,300
£1,400
£1,500
£1,600
£1,700
£1,800
£1,900
£2,000
£2,500
£3,000
£3,500
£4,000
£4,500
£5,000
Mortgage Company
Mortgage Term Remaining
Years
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Months
0
1
2
3
4
5
6
7
8
9
10
11
12
Type of Mortgage
-Please Select-
Deferred
Endowment
Flexible
Interest Only
Isa
Low Start
Pension
Repayment
No Mortgage
Property Jointly Owned?
Yes
No
Was your property previously owned by council?
Yes
No
Any arrears in the past 12 months?
Yes
No
Do you have any other loans secured against your property?
Yes
No
Are you a UK resident?
Yes
No
Do You Have Permanent Resident Rights in the UK?
Yes
No
What discount did you receive from council?
What did the council value the property at for the purchase?
Did you purchase as a sitting tenant?
Yes
No
Which lending institution has your secured loan?
How much is left on the loan?
What are the present arrears on your mortgage?
What is the highest your arrears has been in the past 12 months? (£)
Have you made your last 3 payments on time?
Yes
No
Your Spouse's Details
Title
-Please Select-
Mr.
Mrs.
Miss
Ms
First Name
Last Name
Date of Birth
MM
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
DD
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
YY
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
Employment Status
Employed Full Time
Employed Part Time
Self Employed
Retired
Student
Housewife
Househusband
Unemployed
Yearly Income (£)
Job Length
-Please Select-
1 Year
2 Years
3 Years
4 Years
5 Years
6 Years
7 Years
8 Years
9 Years
10 Years
11 Years
12 Years
13 Years
14 Years
15 Years
16 Years
17 Years
18 Years
19 Years
20 Years
21 Years
22 Years
23 Years
24 Years
25 Years
26 Years
27 Years
28 Years
29 Years
30 Years
Spouse's Maiden Name? (Leave Blank if spouse is male)
Does Your Spouse Have Permanent Resident Rights in the UK?
Yes
No
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