Mortgage Questionnaire

Personal Details

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

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

Income (per annum)

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

Monthly Expenditure

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

	Self	Partner	Joint
Total Disposable Income	Total Disposable Income, Self:	Total Disposable Income, Partner:	Total Disposable Income, Joint:

Assets

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

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

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

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

Bankers

	Self	Partner	Joint
Bank name/address	Bank name/address, Self:	Bank name/address, Partner:	Bank name/address, Joint:

Existing mortgage(s)

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

Other liabilities

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

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