Mortgage Questionnaire

Personal Details

Please leave blank:

	Self	Partner
Mr/Mrs/Miss
Surname and Maiden Name
Forename including Middle Names
Address
Postcode
Tel Number - Home
Tel Number - Work
Tel Number - Mobile
Email Address
Marital Status
Date of Birth
Nationality

Do you have any financial dependents?

If yes to above

Name:

Age:

Name:

Age:

Name:

Age:

We recommend a full review of both your mortgage and insurance needs in order to ensure you are adequately insured, have the mortgage appropriate to your needs/circumstances and to minimise your costs.

Please review all my mortgage and insurance needs (complete insurance questionnaire) Please review my mortgage needs only

Occupation

	Self	Partner
Job Title
Employment Status
Is your employment permanent, temporary or contract work?
Time in current employment?
Date any probation ends?
Employers name and address
If employed less than one year, details of your previous occupation & dates
What is your planned retirement date?

Income (per annum)

	Self	Partner	Joint
Basic salary
Other guaranteed employment income
Other non guaranteed employment income
If self employed: net profit assessable to tax for last 3 years - Last year
If self employed: net profit assessable to tax for last 3 years - Year 2
If self employed: net profit assessable to tax for last 3 years - Year 3
Pension income
Investment income
Rental income
Other income
Total Gross income pa
Total net monthly income

Monthly Expenditure

	Self	Partner	Joint
Mortgage/rent
Credit Card Payments
Loans/hire purchase
Other debts
Life assurance
Household costs
Car/travel
Social
School fees
Maintenance
Other (specify)
Mobile
Total Outgoing

	Self	Partner	Joint
Total Disposable Income

Assets

	Self	Partner	Joint
House value
Other property
Bank & B/Society
Equity investments
Other investments
Total of Assets

	Self	Partner
Have you made a will? If yes is it up to date?

Residential Situation & Credit History (please give further details on Page 8, if applicable)

	Self	Partner	Joint
Owner/tenant/LWP/other?
If renting, how much do you pay per month?
Are you on the electoral role?
Length of time at current address
Other address(es) within last 3 years (including; postcode, dates of residence, whether tenant or owner)
National Insurance Number
Have you ever had a loan or mortgage application refused?
Have you ever had a judgement for debt or default registered against you? If yes - date, amount, lender, is judgement still outstanding?)
Have you ever been declared bankrupt or made arrangements with your creditors?
Have you ever failed to keep up repayments on any mortgage, rental or loan agreement?

Bankers

	Self	Partner	Joint
Bank name/address

Existing mortgage(s)

	Self	Partner	Joint
Amount outstanding
Mortgage term remaining
Repayment/interest-only/flexible
Lender
Current monthly payment
Interest rate
Charge for transferring or repaying your mortgage?
Is it portable to a new property?
Current property valuation?

Other liabilities

	Self	Partner	Joint
Personal Loans - Amount & Repay
Credit Cards - Amount & Repay
Store cards - Amount & Repay
Overdrafts - Amount & Repay
Other Liabilities
Total Remaining Liabilities

New mortgage required

Please state whether the mortgage is for your main residence, a buy to let property or your 2nd home?

Are you purchasing or remortgaging?

Are you a first time buyer?

Address of property to be mortgages? (please supply full postcode):

Purchase price or value or property to be mortgaged?

Amount of mortgage required?

Deposit available?

Do you wish to add any out standing loans to the mortgage or capital raise for other reasons?

Over what term would you like to take your mortgage?

Property to be mortgaged - details

Is the property freehold or leasehold?

House/bungalow/flat/other?

Detached/semi-detached/terraced/other?

Number of floors in block, if a flat?

Number of bedrooms?

Type of construction (e.g. brick/tile)?

Year built?

Rebuild value (for insurance purposes) if known?

Notes:

Declaration:

I/We confirm that the information contained herein is correct to the best of my/our knowledge & consent to it being used for the purpose of arranging financial services on my/our behalf. I/We agree to future contact in order to service our financial needs. I/We have received a copy of the Initial Disclosure Document and/or Terms of Business.

Date:

Please confirm:

You have read the Data Privacy Policy