Mortgage and Insurance Fact Find

Applicant Details

Applicant 1 Applicant 2

Title

First Name

Middle Name

Surname

Previous Surname

Marital Status

Present Address

Date Moved in

Sex

Date of Birth

Age Next Birthday

Telephone numbers - Home

Work

Mobile

E-mail

Residential Status

Preferred Time

Relationship to other applicant

Tax Rate

Nationality

Do you have any Dependants

Dependent First Name Surname Date of Birth Age Gender Financially

Upon Dependent

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Current Employment Details

Applicant 1 Applicant 2

Main Employment status

Basis of employment

Employer Name

Employer address

Works / Staff No

Occupation / Job Title

Start date

Details of probationary period, if any

National Insurance Number

Income Details

Applicant 1 Applicant 2

Employed:

Basic salary p.a

Guaranteed additional p.a.

Regular additional p.a.

Self-employed:

Number of years accounts available

Net profit last year (before tax)

Previous year

Year before that

Monthly Net Income

Total combined income

Benefits/Tax Credit

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Source Annual Amount Gross Notes

Budget Planner

Transport 1st applicant 2nd applicant

Fuel

Road Tax

Insurance

Servicing

Parking

Fares (Travel Card/Season Ticket)

Transport Total

Gas/Other Heating

Electricity

Water

Telephone/Broadband

Digital/Cable TV

TV Licence

Council Tax

Ground Rent

Utility and Other Bills Total

Food

Clothing

Personal Goods (e.g. toiletries)

Mobile Phone

Household Goods (e.g. furniture/appliances)

Entertainment/Recreation

Alcohol/Tobacco

Holidays

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Maintenance for Dependants

Pensions

Insurances

Savings/Investment

Other Monthly Outgoings

Mortgage

Total

Agreed monthly budget

Current Mortgages/Unencumbered Properties

Do You own a Property

Lender

Owner/FTB

New Property address

Property year built

Property number of bedrooms

Property type

Freehold/Leasehold

Property Value

Loan Amount

Loan to Value

Term (years)

Are you borrowing an additional amount, and what for ?

Amount

Finance & Loan

Applicant Company Outstanding Payment

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Current Life Cover/Savings/Investments

Product Provider Payment Balance/Sum Assured Term

Adverse Credit History

Applicant 1 Applicant 2

Have you ever had any adverse credit issues or mortgage/loan refused?

(If No, the remaining questions in this section are not applicable)

Have you ever had a mortgage or a loan application refused?

Have you ever had a judgment for debt or a loan default registered against you?

Have you ever been declared bankrupt or made an arrangement with your creditors?

Have you ever failed to keep up your payments under any previous or current mortgage,
rental or loan agreement?

If you have answered ‘Yes’ to any of the above please enter details in this section

Type Company Amount Client Date Settled

Bank Details (this detail will be destroyed after setting up your direct details and paying for valuation)

Bank Name

Account Holders Name

Account Number (for direct debit

purpose)

Soft Code

Long Card Number

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Issue Date/ Expiry Date

Security Number on Bank

Mortgage Payment Date? Eg 1st Monthly

Mortgage Preferences

Do you have a specific preference for any of the following features as part of your mortgage?

BUDGET

AMOUNT

TERM

REPAYMENT TYPE

INCOME

PRODUCT TYPE

Solicitors Details

Name

Address

Telephone Number

Contact Name

Email Address

Data Protection

I consent to the information you hold about me being processed and held on computer or paper files.

I consent to any information that I give to be disclosed to third parties e.g. credit reference agencies and product providers for the purpose
of my application.

I confirm that I have the permission of any other person mentioned to provide any information contained in this document.

I confirm that this declaration has been signed in the UK and that I am a UK resident.

I consent to the data being checked and / or disclosed to the regulatory authorities as part of compliance monitoring activities.

Declaration

In order to advise you properly, we must obtain certain information from you about your financial and personal circumstances, to assess
your suitability for particular products and services.

I have read this document carefully and confirm that the information contained within is true and accurate to the best of my /our
knowledge.

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Adviser Signature __________________________ Date ___________________

Adviser Name

Applicant 1 Signature ___________________________ Date ____________________

Applicant 1 Name

Applicant 2 Signature ___________________________ Date ____________________

Applicant 2 Name

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