Appointed Representative- Mortgage Advice Bureau
Referring Adviser
*
First Name
Last Name
Referring Adviser Email
*
example@example.com
Midas Pro case ID
*
FRN
*
Firm Name
*
Customer Name
*
First Name
Last Name
Customer Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Type of Purchase
*
New Purchase
Remortgage
Buy To Let (New Purchase and Remo)
Property Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is this property split into multiple addresses?
Yes
No
Additional Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Additional Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Additional Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Additional Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Type of Ownership
Freehold
Leasehold
Is this a HMO Property?
Yes
No
Type of Property
*
Semi Detached House
Mid-Terrace House
End-Terrace House
Detached House
Flat/Maisonette
Other
Is this property a new build?
Yes
No
Number of Bedrooms
*
1
2
3
4
5+
Number Of Occupants
*
1
2
3
4+
When are you most at home?
*
All day everyday
Evenings and Weekends
Weekends Only
Other
Are you on a dual tariff?
*
Yes
No
What do you typically spend on electricity annually? (£)
*
How much loft insulation do you have? (Optional)
Less than 100mm (4 Inches)
100mm-200mm (4-8 Inches)
200mm-300mm (8-12 Inches)
> 300mm (>12 inches)
Have you made any energy efficiency related changes to your property since your last EPC?
Yes
No
What changes have you made?
Cavity Wall Insulation
Loft Insulation
Change of heating system
None
Other
Do you own an electric vehicle?
Yes
No
Do you have a home EV charging point?
Yes
No
Submit
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