Loan Application Form

Please complete our application form. If you have any questions just call us on 01840 212832
Broker Details

(leave blank if you are applying direct)
Introducer Name

First NameLast Name
Firm Name
Phone
Email
example@example.com
Address

Street Address Line 2

CityCounty

Postcode
Regulation
Are you regulated by the FCA?

YesNo
If YES please provide your FCA Registration Number:
Do you conduct anti-money laundering checks on your clients?

YesNo
Applicant Details

DATA PROTECTION - Unless (a) this form is signed by the applicant or (b) you hold the applicant’s consent to share their data with us, do not fill in this area.
Name (List the full names of all applicants)
Phone
Email
example@example.com
Address (Contact address NOT the security address)

Street Address Line 2

CityCounty

Postcode
Note – if the applicant is a company, Friendly Society, LLP or Registered Society, guarantees will be required. Please set out at the end of the form full names and addresses of at least two guarantors. If the property is owned by trustees give details of all of them, on a separate sheet if necessary
Security Property Details
Address (List the full address of each property)

CityCounty

Postcode
Land Registry Title Number (If known)
Type of property
If OTHER please elaborate
Current Lender
Amount Outstanding
Value of Property
This is:
* If a valuation has been carried out already, it must be attached.
Valuation upload

If you have a valuation of the property, please upload a copy here by browsing and selecting the appropriate file.
Cancelof
If the property is being purchased, the purchase price is
Loan Requirements
Amount of loan requested (Please specify net or gross)
Maximum 65% of valuation
Purpose of Loan
Source of balance of funds
to complete purchase/redeem mortgage(s)
Regulation*

YesNo
*The loan will not be a regulated contract within the meaning of the Financial Services Legislation

Applicant's Solicitor's Details

PLEASE NOTE - Solicitors will be required to act very quickly. Any offer will only last for 28 days. It is essential that solicitors are instructed promptly. They will almost certainly require money on account for searches. Please ensure that they are instructed and placed in funds as soon as any offer is accepted.
Company Name
Name of person dealing
Solicitor's address

Street Address Line 2

CityCounty

Postcode
Phone
Email
Guarantors

if applicant is a company, Friendly Society, LLP or Industrial and Provident Society.
Guarantor 1 Details
Name

First NameLast Name
Address

Street Address Line 2

CityCounty

Postcode
Phone
Email
Guarantor 2 Details
Name

First NameLast Name
Address

Street Address Line 2

CityCounty

Postcode
Phone
Email
Where did you hear about us?
Additional Questions
Please confirm whether there is a deadline we need to complete by and the relevance of this date (e.g. end of current mortgage term or completion date.)
Have you agreed with the applicant that a broker fee will be paid to you on completion of the loan (excluding commission) and if so, how much?
We are registered with the Office of the Information Commissioner (number Z9845647 ) for the purposes of the Data Protection Act 2018. We will store your data in accordance with that Act. Please refer to our for more details.
Should be Empty:

Please complete our application form. If you have any questions just call us on 01840 212832

Broker Details

Regulation

Applicant Details

Security Property Details

Loan Requirements

Applicant's Solicitor's Details

Guarantors

Guarantor 1 Details

Guarantor 2 Details

Additional Questions