Inheritance Loan Application Form

Inheritance Loan - Application Form

Please complete the details below to apply for an Inheritance Loan for your client.

We recommend you save your application throughout, should you need to return to complete at a later date. You can do this by selecting the Save button, at the bottom of each page.

If you have any questions, please call us on 0800 009 6590 or email us at probate@amplafinance.com.

Inheritance Loans are provided by Ampla Consumer Finance Limited.

The Borrower:

	True	False
Currently lives in and has been a resident of England, Scotland, or Wales for more than 12 months.
Is not currently in, or planning to enter into, an IVA or declare bankruptcy

Regarding the deceased:

	True	False	Not Applicable
The deceased was resident and domiciled in England, Scotland, or Wales at the time of their death.
If the deceased left a will: This provides for (where relevant) any Spouse, partner, surviving children and step children.
If the deceased left a will: The will and any codicils / letters of wishes were made when the deceased was of sound mind and not suffering from any mental illness, including dementia.

Regarding the estate:

	True	False
The estate is not subject to any known or anticipated disputes, whether settled or unsettled.
The estate assets are located in England, Scotland, or Wales.
The estate has valid buildings insurance for any property assets.
The estate is expected to be liquidated and the inheritance available to repay the loan within 12 months.

Intermediary declarations:

	True	False
I agree to receive electronic communications from Ampla Finance regarding the application.
I consent to the processing of my personal/company data in accordance with the Ampla Finance Privacy Policy.
I confirm that the Borrower has given their explicit consent for Ampla to record and store any special category data that is confirmed during the application process.
I agree to receive marketing communications from Ampla Finance about products, services, and promotions. I understand that I can unsubscribe at any time.

Introducing Firm:

Details of the firm completing the application on behalf of the Client
Name*
Company Name*
Email*
Contact number*
Do you or the client have any practical needs to help complete the application*
For example: large print, braille or alternative language
Client Details:

Details of the Client(s) you are making an application for
Number of Applicants
Applicant 1 Name*
Applicant 1 Date of birth (DD/MM/YYYY)*
Nationality*
Applicant 1 Current address*
Has the client lived at the above address for more than two years?*
Please provide addresses for all properties the client has resided at over the past 2 years
Applicant 1 Email*
Applicant 1 Contact number*
Applicant 2 Name*
Applicant 2 Date of birth (DD/MM/YYYY)*
Nationality*
Applicant 2 Current address*
Has the client lived at the above address for more than two years?*
Please provide addresses for all properties the client has resided at over the past 2 years
Applicant 2 Email*
Applicant 2 Contact number*
Country of residency*
Have any Applicant(s) got any unspent criminal convictions?

The Applicant(s) do not have any unspent criminal convictionsThe Applicant(s) do have unspent criminal convictions
Please provide further detail regarding the Applicant(s) unspent criminal conviction:
Employment status*
Occupation
Employer
Years with employer
Personal annual income*
Personal annual expenditure*
Do the Applicant(s) have any health concerns or diagnosed conditions?*

YesNo
Please confirm the nature of their conditions

Mental healthPhysical health
Please provide further details
Does this affect their capacity to contract?

YesNo
Is there a power of attorney in place?

YesNo
Name of power of attorney

First NameLast Name
Contact number for power of attorney
Contact number
Is there any additional support we can put in place to assist your client with the application, or during the loan lifecycle?

N/ABrailleCopying a 3rd party into written communicationsLarge FontOther
Please confirm the additional support required

Details of the loan required
Please list any building improvements that need to be made before a sale can go ahead?
Has a conveyancing firm been instructed?
What stage is the sale at?
How much would your client like to borrow from Ampla Finance?*
We lend from £10,000 upwards
Are you charging the client(s) a fee in relation to the application? If so, please confirm the amount
Is this fee to be added to the loan, or paid upfront?

Added to the loanPaid Upfront
Please confirm the purpose of the loan*
When does your client wish to receive the funds from Ampla Finance?*
When do the Client(s) expect to receive their inheritance and repay the Ampla loan?*
Maximum term of 12 months

Executor Details
How many Executors are there?*

123+
Please enter details of the first Executor
Please enter details of the second Executor
Please enter details of the third Executor

Professional Firm Details
If a professional firm is instructed, please enter their details below
The Professional Firm has been instructed to manage (select all that apply)
Are any other Professional Firms involved

YesNo
Please enter details of the professional firm
The Professional Firm has been instructed to manage (select all that apply)
Are any other Professional Firms involved

YesNo
Please enter details of the professional firm
The Professional Firm has been instructed to manage (select all that apply)

File uploads and Declarations.
Is your client currently seeking or involved in any IVA, Trust Deed, Bankruptcy, Debt Management Plan or Debt Relief order?

NoYes
Please provide details?
Please confirm the bank details the funds should be sent to if the application is successful:
A copy of the deceased’s Death Certificate

Cancelof
A copy of the will (for estates with a will)

Cancelof
Certified copy of the Grant of Probate (for estates with a will), or Grant of Letters of Administration (for intestate estates)

Cancelof
Certified copy of IHT Forms and any supporting schedules

Cancelof
Instruction letter(s) from professional firm(s) appointed to settle the estate

Cancelof
Any additional information on the assets and liabilities in the estate

Cancelof
By signing this form, I confirm that as the introducer of the above named client(s):*

The information provided on this application form is correct to the best of my knowledge;I am authorised by all the client(s) named above to submit this application on their behalf;All the Client(s) named above have been provided with a copy of the Ampla Finance Privacy Policy;All the Client(s) named above provide their consent for Ampla Operations Limited to perform third party checks as detailed in Section 4 of the Ampla Finance Privacy Policy;All the Client(s) named above give their authorisation for Ampla Operations Limited to share their information with the other Client(s), the Executor(s) and the Professional Firm(s) managing the Deceased’s estate; andAll the Client(s) named above give their authorisation for the other Client(s), the Executor(s) and the Professional Firm(s) to provide information relating to the estate to Ampla Operations Limited.
Signature*

Clear
Print Name*
Date*

MonthDayYear
Should be Empty:

Introducing Firm:

Client Details:

Details of the loan required

Details of the Deceased and the Estate

Executor Details

Professional Firm Details

File uploads and Declarations.