MORTGAGE ENQUIRY

Applicant 1

Applicant 2

Title:

First Name:

Surname:

Date of birth (dd/mm/yyyy)

Address:

Postcode:

Time at above address:

years* months *

years months

Contact telephone:

E-Mail:

Marital status:

On electoral register?

Residential status:

Employment & Financial Details

Employment status:

Gross annual earnings:

£ *

Other income per annum:

Loans outstanding
(excluding mortgages)

Monthly repayments on the above:

Mortgage Details & Property Details

Amount and repayment type:

£ *

Term and rate preferred

years*

Type of Mortgage Required

This is a lifetime mortgage. To understand the features and risks, ask for a personalised illustration.

Purchase price

£ *

Existing mortgage lender
(if any)

Other Information
e.g. arrears, ccjs guarantors etc

Your home may be repossessed if you do not keep up repayments on your mortgage.

You Voluntarily choose to provide personal details to us via this website. Personal information will be treated as confidential by us and held in accordance with the Data Protection Act 1998. You agree that such personal information may be used to provide you with some details of services and products in writing, by email or by telephone.