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Enquiry form
Step 1
First Applicant details
Title
Forename
Surname
Date of Birth
Nationality
Marital Status
Relationship to other applicant
Smoker?
Address
Number of dependants
0
1
2
3
4
5
6
7
8
9
Current residential status
Owner
Tenant
LWP
Other
Are you on the electoral roll there?
Length of time at current address
Telephone Number (home/work)
Telephone Mobile
Email Address
Adverse History
Date IVA/CCJ registered
Date IVA/CCJ satisfied (if applicable)
Reason for IVA/CCJ -Details/reasons required
Additional Applicants
Applicant 2?
Next
Step 2
Second Applicant details
Title
Forename
Surname
Date of Birth
Nationality
Marital Status
Relationship to other applicant
Smoker?
Address
Dependants
0
1
2
3
4
5
6
7
8
9
Current residential status
Owner
Tenant
LWP
Other
Are you on the electoral roll there?
Length of time at current address
Telephone Number (home/work)
Telephone Mobile
Email Address
Adverse History
Date IVA/CCJ registered
Date IVA/CCJ satisfied (if applicable)
Reason for IVA/CCJ -Details/reasons required
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Next
Step 3
First Applicant Occupation Details
What is your occupation/job title?
Employment Status – Are you?
Employed
Self-employed
Contract worker
Pensioner
Other
Time in current employment
Expected retirement age
Employers Name and Address
Are you a member of an occupational pension scheme?
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Next
Step 4
Second Applicant Occupation Details
What is your occupation/job title?
Employment Status – Are you?
Employed
Self-employed
Contract worker
Pensioner
Other
Time in current employment
Expected retirement age
Employers Name and Address
Are you a member of an occupational pension scheme?
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Next
Step 5
First Applicant Income Details
Employed
Basic Salary
Overtime, etc
Regular Additional Income (e.g. pensions, rental, investment, state benefits)
Bonus
Self Employed
Number of years accounts available
Net Profit last year
Previous year
Year before that
Details of benefits/tax credits
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Step 6
Second Applicant Income Details
Employed
Basic Salary
Overtime, etc
Regular Additional Income (e.g. pensions, rental, investment, state benefits)
Bonus
Self Employed
Number of years accounts available
Net Profit last year
Previous year
Year before that
Details of benefits/tax credits
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Next
Step 7
Property to be mortgaged
No details as not found property
Mortgage-type
Buy to Let
Remortgage
Purchase
First Time Buyer
Right to Buy
Shared
Ownership
Help to Buy
Other
Address of property to be mortgaged (including postcode):
Property Type
House
Bungalow
Flat
Maisonette
Other
Ex-Local Authority Owned?
Tenure
Freehold
Leasehold
Lease remaining
Construction
Type
Detached
Semi
Terraced
No of Bedrooms
Property Age
Purchase Price / Value
If remortgage, purpose of additional funds
Amount of deposit available
Source of deposit
Total Amount to Borrow
Percentage if shared ownership
Term
Budget
Additional Notes
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Next
Step 8
Foreseeable changes
Are there any foreseeable changes to your circumstances?
Applicant 1
Applicant 2
If Yes, provide details including approximate timescale, amount, reason
Might your income or expenditure change significantly within the foreseeable future?
Applicant 1
Applicant 2
If Yes, provide details including approximate timescale, amount, reason
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Next
Step 9
Health questions - First Applicant
Do you smoke? Cigarettes or Vaping
If yes, how many cigarettes do you smoke per day?
If no, have you ever smoked?
How old were you when you started?
If applicable, when did you stop? And how many cigarettes did you used to smoke?
Do you have any health issues that could affect you getting life cover?
What is your height?
What is your weight?
Are you waiting for any tests/results/examinations/operations?
Additional Medical Notes
Health questions - Second Applicant
Do you smoke? Cigarettes or Vaping
If yes, how many cigarettes do you smoke per day?
If no, have you ever smoked?
How old were you when you started?
If applicable, when did you stop? And how many cigarettes did you used to smoke?
Do you have any health issues that could affect you getting life cover?
What is your height?
What is your weight?
Are you waiting for any tests/results/examinations/operations?
Additional Medical Notes
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Next
Step 10
Additional Notes
Additional Notes
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Submit
