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Name

First

Last

Phone Number

Address

Single Line Text

City / Town

Region

Post Code

Date of Birth

DD/MM/YYYY

Gross Annual Income

Benefit Income? Type and amount

Employment Status

Loan Required

Minimum £10,000

Loan Type

Loan Purpose

Term

Months / Years

Homeowner

Property Value

Mortgage Balance

Mortgage Company

Monthly Payment

Is this property under any Help to Buy/Shared Ownership or Right to Buy Schemes?

Any missed mortgage payments

Any missed unsecured loan payments

Any IVA, DMP, or Bankruptcy Order?

Current Credit Profile?

Outstanding credit after the loan? Total and monthly payment:

Any dependents? If yes what ages:

Any childcare/maintenance costs:

Reason not re-mortgaging?

Any Additional Comments

Confirmation