| About You |
FIRST APPLICANT |
SECOND APPLICANT |
| *Title |
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| *First Name |
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| *Surname |
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| Maiden Name (leave blank if n/a) |
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| *Date of Birth (example: 05/08/1960) |
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| *Sex |
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| *Nationality |
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| *Marital Status |
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| *Living Status |
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| *Number of Dependants |
Children |
Children |
| Address Details |
| *Current Address (3 years) |
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| *Town / City |
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| *Postcode (example: GU22 5DQ) |
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| *Time at Current Address |
Years Months |
Years Months |
| Previous Address (if less than 3 years) |
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| Town / City |
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| Post Code |
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| Time at Previous Address |
Years Months |
Years Months |
| Main Contact Details |
| *Email Address |
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| *Contact Phone Number |
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| *Alternative Number |
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| *Call Back When? |
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| Employment & Income |
| *Employment Type |
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| Occupation |
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| Time in job |
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| Probationary |
No Yes - to go? |
No Yes - to go? |
| *Salary per annum, before Tax |
Basic £
Overtime £
Commision £ |
Basic £
Overtime £
Commision £ |
| Previous Employment Detail if less than 3 years |
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| Financial Commitments |
| Total Outstanding unsecured Debt Balance |
£ |
£ |
| Mortgage/secured Debt Balance |
£ |
£ |
| *Total Monthly Payments |
£ |
£ |
| Property & Financial Information: |
| *Product Required |
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| *Mortgage needed in... |
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| *Amount to Borrow (the Mortgage) |
£ |
| *Property Value |
£ |
| Financial History: |
| *Poor Credit |
Yes No |
Yes No |
Yes = Known Poor Credit, Subprime/Adverse mortgage needed.
No = Prime Mortgage - Never been Bankrupt /Repossed. No arrears, County Court Judgments (CCJs) or Defaults. |
| NOTES Please give us details of any information that you may think is important, e.g. bankruptcy, repossessions, previous addresses, employment history, etc. |
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| Marketing Permission |
We would like to tell you about products & services, offered by other carefully selected companies, we believe would be of interest to you.
Uncheck boxes to deny permission. |
Letter Phone Email |
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*Read & check box that you have Read and Understand the Declaration
Submitting this form authorises contact for an initial Mortgage consultation by phone.
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Think carefully before securing other debts against your home.
Your home may be repossessed if you do not keep up repayments on a mortgage or any other debts secured on it.
Written quotations on request. Loans subject to status and secured on the property.
MDJ & Partners Ltd, Bluebell Barn, Long Lane, Banham, Norfolk. NR16 2DF
Data Protection: P29148781 | Consumer Credit Licence: 577131
DPA & Privacy:
Website conforms with Data Protection Act 1988.
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FSA:
MDJ & Partners Ltd do not issue Mortgages nor lend monies.
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