Section 1 - Primary Details
Client 1
Title
Mr
Mrs
Miss
Ms
Dr
arrow&v
Gender
Male
Female
arrow&v
Do you smoke?
Yes
No
arrow&v
Residential status
Home owner
Living with parents
Living with other
Renting private
Renting social
arrow&v
Marital status
Married
Single
Separated
Divorced
Co-habiting
Widow
Widower
Civil partnership
arrow&v
Client 2
Title
Mr
Mrs
Miss
Ms
Dr
arrow&v
Gender
Male
Female
arrow&v
Do you Smoke?
Yes
No
arrow&v
Residential status
Home owner
Living with parents
Living with other
Renting private
Renting social
arrow&v
Marital status
Married
Single
Separated
Divorced
Co-habiting
Widow
Widower
Civil partnership
arrow&v
If you have lived at your current address for less than 6 years then please give previous address
Residential status
Home owner
Living with parents
Living with other
Renting private
Renting social
arrow&v
Residential status
Home owner
Living with parents
Living with other
Renting private
Renting social
arrow&v
Section 2 - Dependants
Client 1
Do you have any dependants
Yes
No
arrow&v
Gender
Male
Female
arrow&v
Gender
Male
Female
arrow&v
Gender
Male
Female
arrow&v
Gender
Male
Female
arrow&v
Gender
Male
Female
arrow&v
Client 2
Do you have any dependants
Yes
No
arrow&v
Gender
Male
Female
arrow&v
Gender
Male
Female
arrow&v
Gender
Male
Female
arrow&v
Gender
Male
Female
arrow&v
Gender
Male
Female
arrow&v
Section 3 - Debts
Please tick the areas which apply to you with regards to your credit history
Client 1
Arrears
Bankruptcy
Default
CCJ
Debt management
IVA-Trust deed
Payday loan
None of the above
Client 2
Arrears
Bankruptcy
Default
CCJ
Debt management
IVA/Trust deed
Payday loan
None of the above
Section 4 - Main Occupation Details
Client 1
Type of employment
Full time
Part time
arrow&v
Main occupation status
Employed
Self employed
Other
arrow&v
Client 2
Type of employment
Full time
Part time
arrow&v
Main occupation status
Employed
Self employed
Other
arrow&v
If you have worked with your current employer for less than 6 years then please give previous details
Type of employment
Full time
Part time
arrow&v
Occupation status
Employed
Self employed
Other
arrow&v
Type of employment
Full time
Part time
arrow&v
Occupation status
Employed
Self employed
Other
arrow&v
Section 5 - Loan details
Purpose of loan
Buying first home
Moving to a new house
Other property purchase
Looking for a new mortgage deal
Financing home improvements
Financing car purchase
Debt consolidation
Divorce settlement
Other
arrow&v
Existing mortgage balance
Bridging loan
BTL - Further advance
BTL - Product transfer
BTL - Purchase
BTL - Re-mortgage
BTL - Secured loan
First time buyer
Further advance
Holiday home
Holiday let
2nd charge mortgage
Let to buy
Mover
Product transfer
Re-mortgage
Right to buy
Right to buy re-mortgage
Second home
Self build
Self build re-mortgage
Shared ownership
Shared ownership re-mortgage
arrow&v
Term
Mortgage repayment type
Capital repayment
Interest only
Part and part
Not sure
arrow&v
Send to broker
