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Your Personal Details Title: Mr. Ms. Miss Mrs. * Your Full First Name and Last Name: * Date Of Birth: Partners full name: Partners date of birth: Marital status: Married Single Divorced Separated Widowed Co-habiting No. of dependants: Current address: Post Code (eg: AB12 3CD): * Time at address: Home Phone: * Work Phone: * Mobile Phone: * If less than 3 years at current address, please give details of previous: Previous address:     Previous Postcode: Time at address:   Your Employment Details Monthly take home pay: Occupation: Employers name: Employer's address:     Postcode: Time with employer: Phone number: If less than 3 years with current employer, please give details of previous: Employers name: Occupation: Full address:     Postcode: Time with employer:     Helpful Information What is the purpose of your loan: Please Select Consolidating Debt Clearing Credit Cards Holiday Home Improvement Car Other Where did you hear of us: Please Select ASK Ask Jeeves AskAlix Espotting Exchange & Mart Excite Find.co.uk FindWhat Freeserve Google Hot Property Newspaper Hot Property Website Kanoodle Looksmart LOOT.com LOOT Newspaper Lycos Mail Mirror Mortgage Magazine MSN Netscape News of the World Ooooops.co.uk Overture Radio Recommended SCOOT Seek.co.uk Sport Sun Thomson Directory TV Advert What Mortgage Webcrawler Yahoo YELL.com Yellow Pages SEARCH ENGINE (state) OTHER MEDIA (state) OTHER WEBSITE (state) Comments: Password (if we need to update your records):     UK RESIDENTS ONLY

Your Partners Employment Details Monthly take home pay: Occupation: Employers name: Full address:     Postcode: Time with employer: Phone Number:   Your Residential Status Are you: Please Select Owner/Mortgage Payer Private Tenant Council Tenant Living with Parents Tenant of Employer Housing Association Shared Ownership If homeowner, please give details: Estimated value: Mortgage outstanding: Name of lender:   About Your Monthly Expenditure Mortgage or rent: Monthly council tax: Endowment premium: Insurance premiums(total):   About Your Existing Borrowing Give details of ALL existing credit and store cards: Description Limit £ Balance £ Settle ? Yes No Yes No Yes No Give details of ALL other finance & loan accounts: Name of company Payment £ Balance £ Settle ? Yes No Yes No Yes No   CCJ's or Finance Defaults  Yes No If YES, enter details below: Date  Amount Balance Satisfied ? Yes No Yes No Yes No Yes No   Your Loan Requirements Ideal Loan Amount: £ * Loan Term: 5 yrs 10 yrs 15 yrs 20 yrs 25 yrs * Would you like Payment Protection Insurance? Yes No Bank:  A/C Name: Sort Code: (eg: 10-20-30) A/C Number:

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