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					        Example Mortgage Questionnaire
This form beginning on page 2 is an example mortgage questionnaire. While the design is a little old
it is being utilised by an IFA for obtaining important information from a client prior to meeting them
in order to save time in the application process for a new mortgage. If you are interested in such a
form it will be re-designed around your own requirements and company image, and with the fields
that you require and in the order you want them.

Please complete some fields on this form (do you not need to complete every field or the whole
form, just a few so that you are satisfied with the results) and then press submit. You will get a
completed copy of the form within a few minutes to the email address you specified below. The
process is completely automatic.

Please enter your email address in this field so you can see the end-results automatically mailed to
you. In the live version, the form is pre-programmed to submit to your email account upon pressing
the submit button.



Email Address: ________________________________
 Submit Form                             Print       Private & Confidential


                                                 Mortgage Questionnaire

                                                                    First Applicant         Second Applicant

Personal Information

Title Mr/Mrs/Ms other (please state)                       ________________________   ________________________

Surname                                                    ________________________   ________________________

Maiden Name (If applicable)                                ________________________   ________________________

Christian Name(s)                                          ________________________   ________________________

Date of Birth                                              ________________________   ________________________

Marital Status                                             ________________________   ________________________

Do you smoke?                                              Yes                  No    Yes               No

Names of Dependents                                        ________________________   ________________________

Dates of Birth of Dependents                               ________________________   ________________________

Current Address                                            ________________________   ________________________
                                                           ________________________   ________________________
                                                           ________________________   ________________________
Post Code                                                  ________________________   ________________________

Time at current address (Yrs / Mths)                                  ____ / ____             _____ / ____
If less than 3 years please continue
On further info sheet with details of how long
Spent at each address/post codes required.


Home Tel No.                                               ________________________   ________________________

Mobile No.                                                 ________________________   ________________________

Email Address                                              ________________________   ________________________

Work Tel No.                                               ________________________   ________________________

Are you on the Electoral Register?                         Yes                  No    Yes               No


National Insurance No.                                     ________________________   ________________________

Employment

Occupation / Job Title                                     ________________________   ________________________

Time in Employment (Yrs / Mths)                                       ____ / ____             ____ / ____




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                                                                Private & Confidential




                                                                               First Applicant          Second Applicant
Employment cont....
Employers Name                                                         ________________________   ________________________

Employers Address                                                      ________________________   ________________________
                                                                       ________________________   ________________________
                                                                       ________________________   ________________________
Post Code                                                              ________________________   ________________________

Full / Part Time                                                       ________________________   ________________________

Employers Business                                                     ________________________   ________________________

Any probationary period?                                               Yes                 No     Yes               No


If Yes, please give details                                            ________________________   ________________________


Employee / Pay Ref No.                                                 ________________________   ________________________

Does your employer provide any death in
service benefits or ill health retirement benefits?                    ________________________   ________________________

If so, do you know what these are?
Please provide previous employment history over the last 3 years
including start dates/ name and address of employer/job title
If not employed over the last 3 years in continued employment
Then please give details of any unemployment/college/illness etc. on
Further info sheet


Income

Gross Income per annum                                                 ________________________   ________________________

Usual Overtime per annum                                               ________________________   ________________________

Usual Bonus per annum                                                  ________________________   ________________________

Is your bonus or overtime guaranteed?                                  Bonus              O/T     Bonus            O/T

Do you have your last 3 months wage slips?                             Yes                 No     Yes               No

Do you have your P60?                                                  Yes                 No     Yes               No

What does your P60 show as your income for the
last tax period?                                                       ________________________   ________________________

Net Income per month                                                   ________________________   ________________________

Anticipated retirement age                                             ________________________   ________________________




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                                                  Private & Confidential




If self employed...                                              First Applicant       Second Applicant



How long have you been trading? (Yrs / Mths)                       ____ / ____            ____ / ____

How many years’ accounts do you hold?                   ________________________   ________________________

Name / Nature of business                               ________________________   ________________________

Name of accountant                                      ________________________   ________________________

Address of Accountant                                   ________________________   ________________________
                                                        ________________________   ________________________
                                                        ________________________   ________________________
Post Code                                               ________________________   ________________________

Tel No of Accountant                                    ________________________   ________________________

Qualification of Accountant                             ________________________   ________________________

What are your net profits for the last 3 years          ________________________   ________________________

For those home movers and those
remortgaging

Present Lender                                          ________________________   ________________________


Lender’s Address                                        ________________________   ________________________
                                                        ________________________   ________________________
Post Code                                               ________________________   ________________________

Account No.                                             ________________________   ________________________

In whose name is the mortgage?                          ________________________   ________________________

When did the mortgage start?                            ________________________   ________________________

Outstanding term of mortgage?                           ________________________   ________________________

Is loan Repayment, Interest Only or both?               ________________________   ________________________

And what amounts and terms are attributed to            ________________________   ________________________
each?

What is your present interest rate, or special deal
rate?                                                   ________________________   ________________________




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                                                                 Private & Confidential

When does the deal expire?                                                        ____ / ____            ____ / ____

Is your loan a fixed or tracker or discount deal?                      ________________________   ________________________

What are the early repayment charges if you repay
before the end of the special deal expires?                            ________________________   ________________________

Value of property?                                                     ________________________   ________________________

What day of the month do you pay your mortgage?                        ________________________   ________________________

Purchase price of existing mortgage                                    ________________________   ________________________

                                                                             First Applicant           Second Applicant
Original mortgage amount                                               ________________________   ________________________
If you own any other properties please furnish with similar answers
on further info sheet


Details of new property if purchasing or
existing property if remortgaging

Purchase Price (if buying)                                             ________________________

Address of new property (if buying)                                    ________________________
                                                                       ________________________
                                                                       ________________________
Post Code                                                              ________________________

Name of estate agents                                                  ________________________

Full address of agents                                                 ________________________
                                                                       ________________________
                                                                       ________________________
Post Code                                                              ________________________

Tel no of agents                                                       ________________________

Fax no of agents                                                       ________________________

Who is dealing with you at the agents?                                 ________________________

If buying or remortgaging would you like us to                         Yes                 No
appoint your conveyance (solicitor) at discounted
fees?

If not please provide address/ name / tel no of your
chosen conveyancer?




Type of property (i.e. semi)                                           ________________________




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                                                Private & Confidential



Garage                                                Yes                No

No. of bedrooms                                       ________________________

Freehold or leasehold?                                ________________________

If leasehold, how many years left on lease            ________________________

Name of Managing Agent (if Leasehold)                 ________________________




Amount of ground rent per annum                       ________________________

What type of Central Heating?                         ________________________

Are walls built of brick or stone?                    ________________________

Is roof tile or slate?                                ________________________

Do you use the property for business?                 ________________________

Is the property above a shop?                         ________________________

Or next to a business premises?                       ________________________

Remortgaging Only

Are you looking to swop over your existing            Yes                No
outstanding mortgage?

Are you looking to raise extra money for home         Yes                No
improvements?

Are you looking to raise extra money for debt         Yes                No
consolidation?

Are you looking to raise extra money for any other    Yes                No
reason?

If so please give details



Are you looking to change the term when you           Yes                No
remortgage?

If so please give details




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                                                Private & Confidential




If looking to raise money for home improvements
what improvements do you intend to make and
what would you consider to be the value of the
property when the improvements have been
made?

If looking to raise extra money for debt
consolidation please confirm which debts you
intend to consolidate and for how much



Buildings Insurance
                                                      First Applicant            Second Applicant

Who is your policy with?                              ________________________   ________________________

When did it start?                                    ________________________   ________________________

Policy No.                                            ________________________   ________________________

What is the sum assured of your buildings             ________________________   ________________________
insurance?

Do you have accidental damage cover on the            Yes                No      Yes                No
buildings?


Do you have legal expenses cover?                     ________________________   ________________________

Have you had any claims in the last 3 years on your
buildings insurance?                                  ________________________   ________________________

If so, please confirm when                            ________________________   ________________________

What were the claims for what amounts                 ________________________   ________________________

                                                      ________________________   ________________________

                                                      ________________________   ________________________

Is your cover index linked?                           Yes                No      Yes                No

Do you have your policy schedule?                     Yes                No      Yes                No




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                                                Private & Confidential




Contents Insurance
                                                      First Applicant            Second Applicant

Who is your policy with?                              ________________________   ________________________

When did it start?                                               ____ / ____            ____ / ____

Policy No.                                            ________________________   ________________________

What is the sum assured of your contents              ________________________   ________________________
insurance?

Do you have any accidental damage cover?              Yes                 No     Yes                No


Are your personal possessions covered away from
the home                                              ________________________   ________________________

Do you have legal expenses cover?                     ________________________   ________________________

Have you had any claims in the last 3 years on your
buildings insurance?                                  ________________________   ________________________

If so, please confirm when                            ________________________   ________________________

What were the claims for what amounts                 ________________________   ________________________

                                                      ________________________   ________________________

                                                      ________________________   ________________________

Is your cover index linked?                           Yes                 No     Yes                No

Do you have your policy schedule?                     Yes                 No     Yes                No

Life Cover

Outstanding terms                                     ________________________   ________________________

Premium per month                                     ________________________   ________________________

Type of policy i.e. decreasing/level                  ________________________   ________________________

Guaranteed premiums                                   ________________________   ________________________

Benefit amount                                        ________________________   ________________________

Who is insured                                        ________________________   ________________________




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                                         Private & Confidential

When do you pay the premium each month         ________________________   ________________________




Critical Illness Cover

Outstanding terms                              ________________________   ________________________

Premium per month                              ________________________   ________________________

Type of policy i.e. decreasing/level           ________________________   ________________________

Guaranteed premiums                            ________________________   ________________________

Benefit amount                                 ________________________   ________________________

Who is insured                                 ________________________   ________________________

When do you pay the premium each month         ________________________   ________________________


First Time Buyers

How much deposit do you have?                  ________________________________________________



                                               First Applicant            Second Applicant
Bank Details

Name of account                                ________________________   ________________________

Account no.                                    ________________________   ________________________

Sort Code                                      ________________________   ________________________

Name of Bank                                   ________________________   ________________________

Address                                        ________________________   ________________________
                                               ________________________   ________________________
                                               ________________________   ________________________
Post Code                                      ________________________   ________________________

When did you open the account                             ____ / ____            ____ / ____




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                                                 Private & Confidential




Adverse Credit Information

Have you ever had a mortgage or loan refused?          Yes                No    Yes             No


Have you ever had a judgement for a debt or a loan     Yes                No     Yes            No
default registered against you?

Have you ever been declared bankrupt or made an        Yes                No     Yes            No
arrangement with your creditors?

Have you ever failed to keep up repayments under       Yes                No     Yes            No
any previous or current mortgage, rental or loan
agreement?


If you have answered yes to any of the above,
please give the following details in respect of your
adverse credit.

When did the situation occur?                          ________________________________________________

In whose name?                                         ________________________________________________

How did the situation occur?                           ________________________________________________

How long was the debt outstanding?                     ________________________________________________


Has the debt been satisfied?                           ________________________________________________




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                                                Private & Confidential

                                             Credit Commitments

                           Hire purchase / Bank Loans / Credit Cards / Store Cards

               For each of your credit commitments shown above I require the following information:

  Whose name? / Which Company? / Purpose of Loan? / Term of Loan? / When loan was taken out? / Amount of
                        Original Loan? / Monthly Payment? / Amount Outstanding?

    I will be unable to give any accurate Mortgage advice until every credit commitment is detailed. Thank you.




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                                    Private & Confidential

                                 Further Requirements

 These documents are only required when mortgage application is completed:

    x Your last 3 months wage slips OR your recent P60 and your last months
        wage slip(s).
    x Either your passports or the paper portion of your driving licences.
    x A utility bill showing both your names and not more than 3 months old
        (mobile bills are unacceptable)
    x Your existing lenders statement showing your monthly payments over the
        last 12 months
    x Have your cheque book at hand in case you need to move swiftly

In order to avoid handing me your original documents you may wish to
photocopy the documents required prior to our meeting, in order that we do
not have to take away original documents.

Thank you.




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                                Private & Confidential

                          Further Information Sheet




               Thank you for your patience in completing this form!




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