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
Page 1
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
Page 2
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
Page 3
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
Page 4
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
Page 5
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.
Page 6
Adviser Signature __________________________ Date ___________________
Adviser Name
Applicant 1 Signature ___________________________ Date ____________________
Applicant 1 Name
Applicant 2 Signature ___________________________ Date ____________________
Applicant 2 Name
Page 7
