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Personal details
Title
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Mr
Mrs
Miss
Ms
Dr
First Name
Surname
Date of Birth
Marital Status
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Loan details
Home Status
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Homeowner
Tenant
Property Value
Mortgage Amount Remaining
Loan Amount
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£100
£250
£500
£750
£1,000
£2,000
£3,000
£4,000
£5,000
£6,000
£7,000
£8,000
£9,000
£10,000
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£16,000
£17,000
£18,000
£19,000
£20,000
£21,000
£22,000
£23,000
£24,000
£25,000
£27,500
£30,000
£32,500
£35,000
£37,500
£40,000
£42,500
£45,000
£47,500
£50,000
£55,000
£60,000
£65,000
£70,000
£75,000
£80,000
£85,000
£90,000
£95,000
£100,000
Loan Purpose
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Repayment Period
1 year
2 years
3 years
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5 years
6 years
7 years
8 years
9 years
10 years
11 years
12 years
13 years
14 years
15 years
16 years
17 years
18 years
19 years
20 years
21 years
22 years
23 years
24 years
25 years
Applicant details
Is this a joint application
Yes
No
2nd applicant gross income
Annual gross income
Credit Rating
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Prime
Sub-Prime
Employment Status
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Employed
Self-employed
Student
Retired
Other
Occupation
Employer name
Payment type
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Printed Wage Slips
Handwritten Wage Slips
No Wage Slips
CIS Card
Audited Accounts
Employed since
Are your wages paid directly into your bank account?
Yes
No
Have you ever been declared bankrupt?
Yes
No
Have you ever been in a debt management programme?
Yes
No
Number of Creditors
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0
1
2
3
4
5
More than 5
If required, could you get
a guarantor for the loan?
Yes
No
Address details
House number/name
Street
Town
County
Postcode
At this address since
Previous address details
(required as you have been living at current address less than 3 years)
House number/name
Street
Town
County
Postcode
At this address since
Contact details
Preferred Call Time
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Morning
Afternoon
Evening
Home tel
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Mobile tel
Email address
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