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Mortgage Application Form
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CMS FSA Registration Number
CMS Contact Name
CMS E-mail
Lender
Mortgage Product/Code
Initial Interest Rate
Type
End Date/Rate Period
Customer Facing Intermediary Firm
Contact Name
Business Address
Postcode
Business Telephone Number
Business Facsimile Number
Mobile
E-mail
Intermediary Firm FSA Number
Directly Authorised Appointed Representative
Network Principal
Network Principal’s Business Address
Postcode
Network Principal’s Telephone Number
Network Principal’s Contact Name
Network Principal’s FSA Number
Appointed Representative Firm Reference Number
Procuration Fee Payment Route Creative Mortgage Solutions Limited Network Principal Intermediary Firm
Y O U R H O M E M AY B E R E P O S S E S S E D I F Y O U D O N O T K E E P U P R E PAY M E N T S O N Y O U R M O R T G A G E
A LENDER FSA REQUIREMENTS
The following questions are to be completed by members of Creative Mortgage Solutions staff only:
1. How much is the Creative Mortgage Solutions Application Fee? £ NB. This includes a processing fee of £125
2. If the mortgage application does not proceed, how much of the Creative Mortgage Solutions Application fee is refunded? £
If none tick box
3. What level of procuration fee will be paid to the intermediary? £
4. Creative Mortgage Solutions is packaging/processing this mortgage application on behalf of the intermediary and will receive a packaging
fee of £
a] What level of procuration fee is passed on to the applicant? All None Part
b] If part how much of the procuration fee is paid to the applicant? £
5. Name of firm is involved in arranging this mortgage.
6. The reason for self certification or self declaration of income
where applicable is:
■ Self employed/contractor
7. This mortgage transaction is: 8. This mortgage transaction is:
■ Earned income derived from various sources
■ Investment income ■ Residential ■ Regulated Loan
■ Other ■ Buy to Let Yes No
B LENDER FSA REQUIREMENTS
The following questions are to be completed by the mortgage intermediary only:
Mortgage Related Questions
1. Was the mortgage sale: Advised Non-advised
2. Was the mortgage sale advised or arranged before 31 October 2004? Yes No
3. Do you charge an intermediary services/broker fee? Yes No If yes how much do you charge? £
4. If the mortgage application does not proceed, how much of your intermediary services/broker fee is refundable? £
5i] Are there any other fees payable? Please state:
£
£
None
5ii] If the mortgage application does not proceed, prior to valuation, offer or completion how much of the
fees stated above [where applicable] will be refunded? Please state:
£
£
Insurance Related Questions
1. Was any single premium insurance policy sold with the mortgage? Yes No
If yes was answered, please provide the following details for each single premium insurance policy sold:
Name of insurer:
Term of insurance policy: years Insurance policy amount: £
Is the insurance premium added to the mortgage loan? Yes No
2. Has the property insurance relating to the property to be mortgaged been sold at a distance, that is by telephone, post, facsimile or internet?
Yes No
Mortgage Advisers Declaration
1. I have undertaken a detailed assessment of the applicant[s] income and expenditure and I believe that the applicant[s] will be able to maintain the mortgage payments, including any possible
increased payments after any benefit period has expired. 2. I confirm responsibility for accuracy of the Key Facts Illustration in respect of the mortgage product applied for which has been
recommended and supplied to the applicant[s]. 3. If the mortgage term extends into retirement, I confirm that the applicant[s] have arrangements in place to enable them to maintain their mortgage
repayments in retirement. 4. If the mortgage is to be repaid on an interest only basis I confirm that I have discussed repayment methods with the applicant[s] and that arrangements have been or will
be made to repay the capital. 5. I confirm I hold the appropriate permissions from the Financial Services Authority [FSA] for the regulated activities I have undertaken in relation to this application.
Print Name
Name of Firm
Signed Date Position
1 PERSONAL DETAILS
1st Applicant 2nd Applicant
1 Title Mr Mrs Miss Other Mr Mrs Miss Other
2 Surnames
3 Forenames
4 Have you ever been known by Yes No Yes No
another name If ‘yes’ please provide
previous name, date of change and reason
for change in Section 17.
5 Date of birth / / / /
6 Nationality
Yes No Yes No
7 Do you have diplomatic immunity?
8 How long have you lived in the UK?
9 Marital Status Married Single Divorced Married Single Divorced
Separated Widowed Living together Separated Widowed Living together
10 National Insurance Number
1 Relationship to Joint Applicant
1
12 Present Address
If correspondence address differs from the
present address please advise us in section 17
Postcode Postcode
13 Home Telephone number
14 Mobile Telephone Number
15 Work Telephone Number
16 E-mail Address
17 How long at your present address? Years Months Years Months
18 Residential Status Owner Living with relatives Renting Owner Living with relatives Renting
19 If less than 3 years at current
address please give previous
address/es Please provide any other
addresses in Section 17
Postcode Postcode
20 How long at this address? Years Months Years Months
21 Residential Status Owner Living with relatives Renting Owner Living with relatives Renting
22 Number of dependents and ages Relationship to applicant Ages Relationship to applicant Ages
Please answer all of the questions in full using BLOCK CAPITALS or ticking the appropriate box. All questions must be
completed. If some questions are not relevant please enter not applicable. Where this form is not completed by the
applicant[s] personally, it is essential that the answers are confirmed as correct by the applicant[s] before signing. Both 1st
and 2nd applicants are required to fill in Sections 1-7, 14 and 15.
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2 PRESENT HOUSING
1st Applicant 2nd Applicant
1 Name and address of
current lender or landlord
Postcode Postcode
£ £
2 Monthly Payment
3 If mortgaged Outstanding loan £ Outstanding loan £
Selling Price £ Selling Price £
4 Date mortgage/rent commenced Month Year Month Year
5 Account number
6 Will you be redeeming your
existing residential mortgage before
Yes No Yes No
[or at the same time as] purchasing
your new property?
7 If Yes to residential mortgage Ex-Marital Renting Ex-Marital Renting
retained, reason for retention?
8 What will be your monthly
£ £
payment on the mortgage you are
retaining on completion of this loan?
9 If your residential mortgage is to
£ £
be retained and rented, what will
the monthly rental income be?
10 Are there any early repayment
Yes No Yes No
charges applicable to your existing
mortgage?
1 Has the mortgage or tenancy
1
Yes No Yes No
been DWP assisted in the last
12 months?
12 Have you received housing
benefit totalling >25% of the Yes No Yes No
monthly payment due in the last12
months?
13 Have you previously owned a
Yes No Yes No
property?
14 Give details of lenders/landlords
in the last three years
If a tenant please provide details of previous
landlords. Use Section 17 if necessary
3 OCCUPATION DETAILS
1st Applicant 2nd Applicant
1 Are you: Are you:
employed contract worker employed contract worker
self-employed controlling director self-employed controlling director
retired other retired other
If you are employed, retired or other please proceed to Section 4 completing the questions where applicable. If you are self-employed please proceed to Section 5 only.
4 INCOME DETAILS - EMPLOYEES IF SELF-EMPLOYED COMPLETE NEXT SECTION
1st Applicant 2nd Applicant
1 Name and address of employer
Postcode Postcode
2 Employer’s telephone number
3 Facsimile number
4 Job description
5 Nature of business
6 Is position permanent?
7 How long have you been
continuously employed in this job?
8 Tax District and reference number
9 Employee or works number
10 Do you own any shares in
Yes No % Shareholding Yes No % Shareholding
the company?
1 How are your wages/salary paid?
1 Cash Cheque Bankcredit Cash Cheque Bankcredit
12 Gross income? Please enclose
Basic £ Basic £
salary/payslips covering the last 3 months
Overtime £ Overtime £
Is this regular? or guaranteed? Is this regular? or guaranteed?
Bonus/Commission £ Bonus/Commission £
Is this regular? or guaranteed? Is this regular? or guaranteed?
Total £ Total £
13 Does any of your income come
from DWP payments? Yes No Yes No
14 Have you ever received state
benefits of over 50% of monthly
payments in the last 12 months? Yes No Yes No
15 If with present employer/s less
than 3 years please provide name
and address of previous employer/s
covering that period. Indicate length
of service and position held with
each firm
(Use Section 17 if necessary)
Postcode Postcode
16 Dates / / / /
17 Position held
18 Other income If necessary please
Description Description
provide source of additional income in Section 17
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19 If you receive rental income please complete further details in Section 17.
20 What is your anticipated
retirement age?
21 If lending into your retirement Type Amount Type Amount
please breakdown the type of
amount of income
If the mortgage term extends beyond retirement age, details should be supplied in Section 17 of how the applicant[s] proposes to maintain mortgage repayments or
any other intended arrangement in retirement.
5 INCOME DETAILS - SELF-EMPLOYED OR CONTROLLING DIRECTORS*
1st Applicant 2nd Applicant
*To include Directors who own or control 25% or more of the voting rights *To include Directors who own or control 25% or more of the voting rights
1 Business description
Private Limited Company Partnership Sole Trader Private Limited Company Partnership Sole Trader
2 Details of business
Public Limited Company Public Limited Company
3 Name and address of company
Postcode Postcode
4 Telephone number
5 Facsimile number
years years
6 How long trading?
7 Company registration and
Reg No. Vat No. Reg No. Vat No.
VAT number
% How long owned? % How long owned?
8 What is your shareholding?
9 Your share of the last 3 years 20 £ 20 £
net profits
20 £ 20 £
20 £ 20 £
Yes No Yes No
10 Do you pay UK tax?
1 Name ad address of Accountant
1
Postcode Postcode
12 Telephone number
13 Facsimile number
Certified/Chartered/Other Certified/Chartered/Other
14 Accountants qualifications
15i) Other income Description Description
If necessary please provide source of
additional income in Section 17
15ii) If you receive rental income please complete further details in Section 17.
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6 INCOME DECLARATION
ONLY SELF-CERTIFICATION APPLICANTS NEED TO COMPLETE THIS SECTION, THEN PROCEED TO SECTION 7
Please ensure that either the employed or self-employed sections are fully completed.
1st Applicant 2nd Applicant
£ per annum £ per annum
1 Total earned income
£ per annum £ per annum
2 Total other income
Reason for self certifying income Reason for self certifying income
3i) Employed only Because you: Because you:
are an existing borrower are an existing borrower
earn commission/bonus based income earn commission/bonus based income
earn from a second income source which is non-PAYE earn from a second income source which is non-PAYE
earn income from a contracts deadline/auction sale earn income from a contracts deadline/auction sale
earn other income earn other income
TICK BOX WHERE APPLICABLE
TICK BOX WHERE APPLICABLE
If other income please state type of income If other income please state type of income
in Section 17 in Section 17
3ii) Employed or self-employed Because: Because:
proof of income is not readily available proof of income is not readily available
there is a deadline there is a deadline
income is derived from various sources income is derived from various sources
please provide a detailed explanation in Section 17 please provide a detailed explanation in Section 17
I/We can afford my/our current and estimated future mortgage payments even if my/our income falls. I/we certify that
if we have applied for a product which either does not require me/us to disclose my/our income, or which permits
me/us to self certify my/our income, I/we understand my/our obligations and I/we have sufficient income [gross
earnings] to support the loan requested stated within the Key Facts Illustration, and, if applicable, that the income
declared is a true accurate assessment of my/our total earned income.
I/We are also aware and fully appreciate the implications the following statements could have on my/our ability
to meet the required monthly mortgage payments:
■ A false declaration of income will have a serious effect on my/our ability to regularly meet mortgage payments.
■ Interest rates are variable and monthly payments may increase over the period of the mortgage.
■ Taking on new or additional financial commitments during the period of the mortgage whilst not receiving any
corresponding increase in income could affect my/our ability to meet mortgage payments.
■ My/Our home may be repossessed if I/we do not keep up repayments on my/our mortgage.
4 Name
5 Signatures
6 Date
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7 OUTGOINGS
Do either of you have or have had any other secured loans/mortgages on this or any other property? Yes No
If ‘yes’ give details in Section 17.
Are either of you currently applying to any other lender for a loan? Yes No
If ‘yes’ give details in Section 17.
Have either of you taken out a student loan? Yes No
If ‘yes’ give details in Section 17.
Please list any other secured or unsecured commitments, i.e. Hire Purchase, Bank Loans/Overdraft,
Credit Cards, Catalogues,Child Support Payments, Second or Subsequent Mortgage Payments, etc.
Applicant Name of Monthly Account Final payment To be
Balance Purpose of loan Secured redeemed on
1 of 2 company payment number Date completion
Yes No Yes No
£ £
£ £
£ £
£ £
If any hire purchase agreement or loans are in arrears please state the number of months in Section 17.
Do you have any other non credit monthly commitments and the amount? [i.e, regular savings, monthly investments]
If ‘yes’ give details in Section 17.
Applicant 1. Are you making any maintenance payments? Yes No If yes, how much? £ How often? Weekly/Monthly
Applicant 2. Are you making any maintenance payments? Yes No If yes, how much? £ How often? Weekly/Monthly
WARNING: Failure to declare any regular and unavoidable personal committed debt required as
above may result in your mortgage application being declined. Please provide full details and use
Section 17 if required.
8 PURCHASES
Both Applicants
£
1 Purchase price
Repayment term required Years
2 Loan required
Yes No
3 Are you a first time buyer?
4 Will this mortgage be for the
Yes No
equal benefit of all named applicants?
If ‘No’ please specifiy for whose benefit the mortgage is being obtained
5 Sale price of existing property if
£
applicable
Amount £ Details
6 Source of deposit
Endowment Repayment Pension Part Capital/Part Interest only Interest only
7 Type of loan
8 If part capital/part interest only
Part Capital £ Part Interest £
please confirm amount
9 Please state how the loan will be
Savings Investments income/vehicle Sale of property
repaid if interest only or part
capital/part interest only
If other please provide details in Section 17
10 Please state any fees which you Fee Amount £
would like adding to the loan Fee Amount £
Fee Amount £
Fee Amount £
1 Please indicate your preferred
1
payment date ie (1st - 28th)
9 PROPERTY DETAILS
Both Applicants
Name and address of Estate Agents/access
1 Name of present owner(s)
2 Full postal address of property to
be mortgaged
Postcode Telephone Number
3 Telephone number for access
4 Are you purchasing as a
Yes No
sitting tenant?
5 Who should we contact for access?
6 Are you purchasing under the Yes No
Right to Buy legislation?
Yes No
7 Is this a private sale?
Yes No If ‘yes’ please give details
8 Are you related to the seller?
Yes No If ‘yes’ please give details
9 Is a Deed of Gift involved?
10i) Is the property to be occupied
Yes No If ‘no’, when will it be occupied?
immediately?
10ii) When is the entry date? (Scotland only)
1 Description
1
Home Bungalow Flat Maisonette
Other Number of bedrooms Number of living rooms
Number of kitchens Number of bathrooms Number of car spaces Number of garages
12 If a flat, please state: What floor in block? Number of storeys Is it purpose built? Yes No
Please state approximate percentage of owner occupation % Is it above commercial Yes No
13 Tenure Freehold Leasehold Commonhold Feudal Shared ownership Shared equity
14 If applicable, state
Unexpired term of lease years
Ground rent of Fee duty £ p.a.
Service Charge £ p.a.
15 Construction
Type: Detached Semi Terraced Other
Walls: Brick Stone Other
Roof: Tile Slate Other
If other please give details.
16 Year of construction ‘New’ if being constructed
17 Is the property less than
Yes No
12 months old?
18 Please provide full names of
anybody 17 years or over(other
than the applicants) who will reside
in the property
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19 Please state the relationship to the 24 Are there any 29 Approximately how
applicant(s) of anybody 17 years or agricultural restrictions? Yes No many acres are included
over who will reside at the property with the property?
25 Is the entire property
20 For Buy to Let schemes only will for you and your 30 Do you intend to let Yes
any related persons live at the property Yes No family’s immediate Yes No the property? If ‘yes’ please
residential use? provide details of the relationship in
No
21 If ‘yes’ to question 19 will the Section 17
relative(s) occupy more than 40% of 26 Is any of the property
the property? If ‘yes’ please provide details of Yes No to be used for business 31 If let, what is the
Yes No
the relationship in Section 17 purposes? expected rental income? £
22 If less than 10 years old is there a 27 Is the property
NHBC Certificate or a Zurich Yes No ex-council/housing Yes No
Municipal Building Guarantee association? p/m
23 Are there any immediate 28 Is full vacant Yes No
Yes No
improvements made to the property? possession being taken
on purchase?
Mortgage Valuation Home Buyers Full Structural
32 Type of survey required
33 Has the property been extended or altered in the last 10 years? Yes No
10 REMORTGAGES
Both Applicants
£ Loan required £
1 Estimated value of property
Date / / Amount £
2 Date and amount of original purchase
£ Repayment term required years
3 Amount originally borrowed
Amount £ Date / / Purpose
4 Details of any further advances
£
5 Please give a breakdown of any
costs incurred with improvements £
carried out since the purchase of the
£
property where applicable
Amount £
6 Mortgage balance outstanding
Yes No
7 Will this mortgage be for the equal
If ‘No’ please specify for whose benefit the mortgage is being obtained
benefit of all named applicants?
Yes No
8 Will there be any extra money raised?
£
9 Please give a breakdown of how
the remortgage monies will be used? £
£
Endowment Repayment Pension Part/Capital/Part interest only Interest only
10 Type of loan
1 If part capital/part interest only
1
Part capital £ Part capital £
please confirm amount
12 Please state how the loan will be
repaid if interest only or part
Savings Investment income/vehicle Sale of property
capital/part interest only
13 Was the original purchase under
Yes No Details
the Right-to-Buy Scheme?
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11 LIFE ASSURANCE
DETAILS OF ALL LIFE AND PENSION POLICIES TO BE USED TO REPAY THE LOAN
Name of assurance company Policy number Life assured (1st/2nd/both applicants) Type of policy Sum assured maturity date
NB. If you are taking out an interest only mortgage which extends into retirement please provide full details of
the associated repayment vehicles either above or in Section 17.
12 SOLICITOR/LICENSED CONVEYANCER
Please note that some lenders will only use solicitors with multiple practising partners.
Both Applicants
1 Name of conveyancing firm
2 Address of your conveyancer
Postcode DX Number
3 Number of solicitor/conveyancer
partners?
4 Name of person acting for you
5 Telephone and facsimile number
6 Do you want the lender to instruct the solicitor on your behalf? Yes No
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13 INSURANCE
DISCLOSURE OF MATERIAL FACTS - DECLARATION
This section MUST be completed irrespective of the applicants insurance intentions
Have you or any member of your household permanently residing with you : Yes No
1 Ever been refused insurance or had any special terms or conditions
imposed by any insurer?
2 Made any claims or suffered any losses for property stolen, lost or
damaged, or had any claims made against you in the last 5 years,
whether insured or not? If yes, please provide dates, amounts and type
of each loss in Section 17
3 Ever been convicted, or have any prosecutions pending, for any criminal
offence [other than motoring offences].
4 Suffered any loss or damage or liability in the last 3 years (can be greater),
whether insured or not, and which would be insured by the insurance you
are choosing
5 Will the property remain unoccupied for more than 30 consecutive days?
6 Is the property to be insured lived in by anyone other than you or your family?
7 If the property is a weekend or holiday home is it likely to be left unoccupied
for more than 40 days at a time?
8 Is the property to be insured used in anyway for trade, professional or business
purposes?
9 Is the property in a sound state of repair?
10 Are you aware of any past or existing structural damage to the property to be insured?
1 Has the property been insured or underpinned or provided with any other means of
1
structural support?
12 Has the property or surrounding area been affected by subsidence, settlement or land slip?
13 If the property had been underpinned or provided with any other means of structural support,
are any other guarantees available?
Please provide any additional information in Section 17.
Buildings Insurance
In all cases buildings insurance must be maintained under a Householder’s Building Policy for a sum not less than that
specified by our valuer. The property can normally be insured through the lender’s insurer and the sum insured will be
based upon an estimate of current rebuilding costs and will be increased in line with the House Rebuilding Cost Index.
You should always ensure, however, that the sum insured is an accurate reflection of the cost of rebuilding your home.
Title Insurance
Is title insurance required on this mortgage? Yes No
If you are unsure of the benefits of title insurance please ask your mortgage intermediary for further details.
Please note
Insurance is subject to the completion of the Mortgage Application Form by all borrowers. This household insurance
policy is underwritten by certain Underwriters arranged on behalf of the lender.
A copy of this application form is available upon request together with a policy booklet.
Please note that there may be an initial charge made on completion should you arrange your own insurance cover and
this will be notified to you in your mortgage offer.
If the property is leasehold and the lease requires cover through an insurance company specified by the landlord then
cover must be effected in accordance with the lease. In all cases where the property will be insured otherwise than
through the Scheme Block Policy, a copy of the insurance policy and last premium receipt must be produced and the
insurance must comply with the criteria set out in the Mortgage, General and Special Conditions.
The parties to this insurance are free to choose the law applicable to it. Unless specifically agreed to the contrary with
the insurers, this insurance shall be subject to English Law.
The insurer may pass your personal data to other companies for processing on its behalf. Some of these companies
may be based outside Europe in countries which may not have laws to protect your personal data, but in all cases the
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insurer will ensure that it is kept securely and only used for the purposes for which you provided it. Details of the
companies and countries involved can be provided to you on request. Insurers and their agents may share information
with each other to prevent fraudulent claims and for underwriting purposes via a Claims and Underwriting Exchange
register, operated by Insurance Database Services Ltd. A list of participants is available on request. The aim is to help us
check information provided and also to prevent fraudulent claims. In dealing with your application this register may be
searched. In the event of a claim, the information you supply on this form and claim form, together with other
information relating to the claim, may be put on the register and made available to other participants. A statement of
cover with full policy wording is available on request prior to cover being arranged.
Does the client wish to take the lenders insurance. Yes No
Details will be supplied with your mortgage offer.
I/we understand that you will pass the information on this form and about any incident I / we may give detail of to IDS
Ltd. so that they can make it available to other insurers. I / we also understand that, in response to any searches you
may make in connection with this application or any incident I / we have given details of , IDS Ltd. may pass information
it has received from other insurers about other incidents involving anyone insured under the policy.
I / we understand that you may ask for information from other insurers to check the answers
I / we have provided.
I / we declare to the best of my / our knowledge and belief the answers given in Section 13 are true and all material
information as explained above has been disclosed.
Buildings and Contents Insurance
A combined buildings and contents plan is available and details, including a quotation, will be sent to you on request.
Do you require details and a quotation? Yes No
Your Own Insurance
Please note that if you wish to arrange your own insurance cover then the lender may wish to approve this. The lender
will make a charge on completion, to cover the additional administration work involved and this will be shown in the
lender’s tariff of charges and notified to you on the mortgage offer.
You should show this notice to anyone who has interest in the property insured under this policy.
Mortgage Payment Protection Insurance Scheme
In view of the reduction of state benefits to mortgage borrowers who have an accident, become ill or
unemployed, you are strongly recommended that you consider a payment protection plan.
Do you require details and a quotation? Yes No
Important Notice
Please sign if you are not taking this cover.
I/We confirm that I/we do not wish to take a payment protection policy. I/We are aware of my/our
continued obligation to make mortgage payments in the event that I/we are unable to work through
sickness or redundancy.
1st Applicant 2nd Applicant
1 Signatures
2 Date
WARNING: MAKE SURE YOU CAN AFFORD YOUR MORTGAGE IF YOUR INCOME FALLS
Disclosure
Any other facts known to you which are likely to affect assessment of the insurance cover you require must be
disclosed in Section 17. Should you be in any doubt about what you should disclose, do not hesitate to tell your
provider. We recommend that you keep a record (including copies of letters) for your future reference, of any
additional information given. Making sure your Provider is informed is for your own protection, as failure to disclose
may mean that your policy will not provide you with the cover you require, or perhaps will invalidate the policy
altogether.
I/We agree that the insurance will not be in force until the application has been accepted by the Company, except to
the extent of any official cover note which may be issued.
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14 CREDIT DECLARATIONS
Yes No Yes No
1 Have you had a mortgage on any other property?
2 Have you had any missed payments with your existing mortgage/rent?
In the last 13 - 24 months?
In the last 7 - 12 months?
In the last 4 - 6 months?
In the last 1 - 3 months?
If ‘yes’ please provide details of amounts/months giving dates and reasons.
Is this a non conforming mortgage?
3 Have you been in arrears with any existing/previous loan secured or unsecured in
the last 24 months?
If ‘yes’ please provide details of amounts/months giving dates and reasons.
4 Have you had a cumulative total of 3 months or more arrears on any secured or
unsecured loan in the last 2 years?
5 Have you ever been insolvent, bankrupt or made a composition with your creditors
or is there an unsatisfied statutory demand in bankruptcy outstanding against you?
If you have been made bankrupt please state in Section 17 the bankruptcy
registration details and discharge date.
If you have had an IVA please state in Section 17 the IVA arrangement and
completion date.
Name and address of supervisor required for IVA
6 Has a County Court Judgement or Court Decree relating to debt ever been made
against you?
If ‘yes’ please provide amount[s], date[s], reason[s], dates[s] satisfied.
7 Has a default relating to debt ever been registered against you?
If ‘yes’ please provide amount[s], date[s], reason[s], dates[s] satisfied.
8 Has a High Court Judgement or Court Decree relating to debt ever been made
against you?
If ‘yes’ please provide amount[s], date[s], reason[s], dates[s] satisfied.
9 Have you ever had a property repossessed [voluntary or not] in the past?
10 Are there any matters which should be brought to the attention of the lender?
1 Have you ever had a mortgage application declined on this or any other property?
1
If you have answered ‘yes’ to any of the above questions, please supply
information in Section 17.
15 YOUR BANKING DETAILS
1 Name and address of
Bank/Building Society
Postcode Postcode
2 Telephone
3 How long have you had an
account with them
4 Account number
/ / / /
5 Sort code
Current Savings Current with interest Current Savings Current with interest
6 Type of account
7 Do you have a cheque guarantee
Yes No Yes No
card?
16 CREDIT/DEBIT CARD PAYMENT FORM
1 Application Fee
£
Note: There is a £125 non-refundable processing
Please debit my credit/debit card account £
fee included in the application fee
2 Name of Cardholder (as on
Card Number
Credit/Debit Card)
Valid from Month Year Expiry Date Month Year Switch Issue Number
Acceptable Cards:
Date Visa Credit, Maestro,
3 Cardholder’s Signature Solo and Mastercard.
17 ADDITIONAL INFORMATION
Please use this page to write down any relevant information as requested in the previous
sections supporting this application. Also indicate to which section and item number each
piece of information is relevant. Use additional sheets of paper if necessary.
Y O U R H O M E M AY B E R E P O S S E S S E D I F Y O U D O N O T K E E P U P R E PAY M E N T S O N Y O U R M O R T G A G E
Y O U R H O M E M AY B E R E P O S S E S S E D I F Y O U D O N O T K E E P U P R E PAY M E N T S O N Y O U R M O R T G A G E
Y O U R H O M E M AY B E R E P O S S E S S E D I F Y O U D O N O T K E E P U P R E PAY M E N T S O N Y O U R M O R T G A G E
If you receive rental income as per Sections 4 and 5 please complete the table below.
Applicant Property/Address Estimated Value Current Mortgage Lender & Mortgage Rental
1 or 2 Details Any further Balance Account no. Repayment
information please
state in box above
£ £ £ p/m £ p/m
£ £ £ p/m £ p/m
£ £ £ p/m £ p/m
£ £ £ p/m £ p/m
Y O U R H O M E M AY B E R E P O S S E S S E D I F Y O U D O N O T K E E P U P R E PAY M E N T S O N Y O U R M O R T G A G E
18 GENERAL DECLARATIONS
To Creative Mortgage Solutions and any mortgage lender which lends me/us money pursuant to
this application ‘The Lender’ includes successors and assigns and those deriving title through it.
I/We declare and undertake that: 5. I consent to the Lender checking my details with a fraud
For the benefit of this declaration ‘the Lender’ also means prevention agency/agencies and if I give false or inaccurate
any non-conforming and specialist mortgage company information and the Lender identifies fraud the lender will
funding the mortgage product applied for. record this. I understand that the Lender and other
organisations may use and search these records to:-
1. The details of this application, any loan the Lender may
make to you, any supporting documentation which you help make decisions about credit and credit related
have or will supply, any documents relating to the title to services. for me and members of my household;
the property or security provided in connection with the help make decisions on motor household, credit life and
loan and the history or conduct of your account(s) with other insurance; proposals and insurance claims, for myself
the Lender, may be held on the Lender’s computer, manual and members of my household;
and other records and processed for the proper conduct trace debtors, recover debt, prevent fraud, and to manage
of the loan and the Lender’s businesses generally including my accounts or insurance policies;
managing your account, statistical analysis, market research
check my identity to prevent money laundering unless I
and fraud prevention. They may be disclosed, subject to
furnish the Lender with other satisfactory proof of identity.
the provisions of the Data Protection Act 1998, to:
6. I/We authorise the Lender to make such enquiries as it
a] Any licensed Credit Reference Agency where they will
considers necessary in relation to my/our application. To
be stored and used by other Lenders for making credit
prevent or detect fraud, or to assist in verifying my/our
decisions about you and other members of your
identity, the Lender may make searches of the Lender
household and occasionally for fraud purposes;
group records and at fraud prevention agencies who will
b] Any insurer or prospective insurer under the mortgage supply the Lender with information. Any information I/we
to help them decide whether to offer cover and for provide may be held by the Lender in its computer
processing claims. records and may be shared within the Lender, and passed
c] Collection agents, to assist in the collection of any to financial and other organisations involved in fraud
arrears and/or administration of the mortgage; and prevention, including National Hunter, to protect the
d] Market research organisations for use for research by Lender and the Lender’s customers from theft and fraud.
the Lender’s group of companies. This information may be made available to other mortgage
lenders where this is done in the interest of fraud
e] The Possessions register maintained by the Council of prevention. If I/we give the Lender false or inaccurate
Mortgage Lenders. information and the Lender identifies fraud, the Lender will
f] Third party providers. record this. The Lender, members of the Lender group,
g] Regulators. and other companies may use this information if decisions
are made about me/us or others at my/our address[es] on
h] Lenders, lawyers, auditors and external advisers. credit or credit-related services or motor, household,
2. The Lender has notified me/us that it processes credit, life or any other insurance facilities. It may also be
“sensitive data” regarding criminal convictions about used for tracing and claims assessment.
applicants as part of risk profiling applications and for 7. I/We understand that the Lender will record details of
insurance purposes. I/We am/are informed that this my/our application at Credit Reference and Fraud
information is only used for assessing risk, the eligibility for Protection Agencies who may keep a record of whether
my/our application for a mortgage and my/our eligibility or not this application proceeds. I/We understand that
under any contract of insurance. I/we consent to sensitive these agencies will link together information in the
data held about me/us being processed in this manner. financial records of my/our financial partners. I/We
I/we consent to the Lender holding securely any medical understand that such linked information will be taken into
health data about me/us. account in all future applications by either of us and that
3. My/our personal information may be disclosed by the this linking will continue until a notice confirming
Lender to other members of the Lender’s group of separation [known as “disassociation”] is successfully filed
companies, other Lenders, transferors, successors in title at these agencies.
any firm to whom the loan may be securitised to and legal 8. I/We understand that you will record details of this
and equitable assigns. These companies may be located in application at Credit Reference Agencies, whether or not
the United Kingdom or other countries in or outside the this application proceeds. An “association” will therefore be
European Economic Area. These companies will hold and created at credit reference agencies which will link our
process this information only for the purposes specified in financial records. I/we understand that our associates
this declaration. Where any of these companies are information will be taken into account unless I/we instruct
located outside the European Economic area the Lender otherwise. If either of us applies for access to information
will first ensure that it has an agreement in place, in which held at Credit Reference Agencies, the applicant will
those companies give equivalent assurances relating to the receive only information relating to him/herself and the
processing, transfer, security and access to personal names of any associate[s]. By signing this declaration I am
information as found in the Data Protection Act 1998. I/We consenting to this.
consent to the Lender disclosing my personal information
in this way. 9. I/We authorise the Lender when making its enquiries to
use appropriate statistical techniques including credit
4. I/We authorise the Lender or its agents to make scoring for assessing my/our application and that my/our
searches about me/us at Credit Reference Agencies who application and that my/our information may be processed
will supply the Lender or its agents with credit information, automatically. I/We understand credit searches may be
as well as information from the Electoral Register. The carried out in the name of another mortgage Lender
agencies will record details of the search whether or not (“Business Partner”) with whom the Lender has an
this application proceeds. The Lender or its agents may arrangement to transfer the mortgage, and that the search
use credit scoring methods to assess this application and details will be recorded on my/credit history. I/We also
to verify my/our identity. Credit searches and other understand that my/our application may be evaluated
information which is provided to me/us and/or the Credit using the credit scoring system of the Business Partner. If
Reference Agencies, about me/us and those with whom my/our application does not satisfy the Business Partner’s
I/we are linked financially may be used by the Lender or its lending criteria, I/we authorise the Lender to place my/our
agents and other companies if credit decisions are made application with another Business Partner or with one of
about me/us, or other members of my/our household. the Lender’s own mortgage products. For this purpose,
The information may also be used for debt tracing and the I/we understand that further credit searches may be
prevention of money laundering as well as the required and I/we hereby authorise multiple credit
management of my/our account. searches to be carried out based on this single application.
Y O U R H O M E M AY B E R E P O S S E S S E D I F Y O U D O N O T K E E P U P R E PAY M E N T S O N Y O U R M O R T G A G E
10. You consent to the Lender, and/or their assignee, successfully files a ‘disassociation’ at the Credit Reference
transferee or chargee of the whole or any part of the Agencies.
Lender’s right, title and interest in and to the mortgage 16. I/We agree that where I/we borrow or may borrow
passing to any actual or potential transferee, assignee, from the Lender, the Lender may give details of my/our
provider of funds or other interested or contracting party account and how I/we manage it to Credit Reference
the details contained in this application, any supporting Agencies. If I/we borrow and do not repay in full and on
documents that are now enclosed or may afterwards be time, the Lender may tell Credit Reference Agencies who
provided, any other documents relating to the title of the will record the outstanding debt.
property, the loan, the mortgage, any collateral security, the
history or conduct of your account [s] or any other 17. The methods of contact to which you consent include
information or documents involving you or the property. automatic calling systems, fax, electronic mail, telephone
[including Interactive Voice Recording facilities], SMS/Text
1 I/We accept that under the Data Protection Act 1998 I
1. messaging, and other online or interactive media. You
am/we are entitled upon payment of a fee to know what agree that telephone conversations and other
personal information is held about me/us by the Lender to communications between you and us or third parties may
know the source of the information, to receive the names be recorded and/or monitored to assist in improving
of the organisations to whom my/our personal customer and collections services.
information will be or has been disclosed and the
purposes for which my/our information will be or has 18. Information given in this application is a true and
been used, and to ask for any inaccurate details to be complete statement, to the best of my/our knowledge
amended, If I/we wish to exercise any of these rights I/we and belief and contains no material omission if any such
should write to the Data Protection Manager at the Lender. information is incorrect, I/we will make good any loss
which the Lender may suffer by acting in such reliance on
12. Please telephone us on 01244 680033 if you want such information. I/we undertake to notify the Lender of
details of those Credit Reference, Fraud Prevention any change in my/our circumstances [which does or may
Agencies and Insurers from whom we obtain and to affect the information herein] prior to any mortgage loan
whom we pass information about you. You have a legal being made by any Lender and I/we authorise my/our
right to these details. You have a right to receive a copy of conveyancer to disclose such information to you. I/we
the information we hold about you if you apply to us in understand that if any answer has been written by any
writing. A fee will be payable. other person, that person shall for that purpose be
13. Information held about me/us by Credit Reference regarded as acting for me/us and not for the Lender. If any
Agencies, may be already linked to records relating to one of the information on this form changes prior to the
or more parties. For the purpose of this application, I/we making of this advance, I/we will notify the Lender in
understand that I/we may be treated as financially linked writing and will not take up the advance unless the Lender
and my/our application may be assessed with reference to has previously consented in writing.
any ’associated records’. 19. I/We authorise the Lender or its agents to instruct a
By stating a financial association with another party, you are qualified valuer to carry out a valuation of the property on
also declaring that you are entitled to: receipt of this application at my/our cost. I/we understand
• Disclose information about your joint application, that the payment of a valuation fee will not bind the
and/or any one else referred to by you, and Lender to grant any advance.
• Authorise us to search, link and/or record information at 20. I/We understand that if this application is successful the
Credit Reference Agencies about you and/or any one else information contained herein forms part of the terms of
referred to by you. the mortgage.
14. I/We understand that once my/our loan, mortgage or 21. I/We understand that where the mortgage is in joint
security for the repayment of any loan or mortgage made names and is subsequently granted, the liability to the
in connection with this application has been transferred or Lender will be joint and several and in the event of the
assigned, the Company may obtain information and data death of either of us, the mortgage account vests in the
from the new Lender about my/our loan, mortgage or survivor.
security for the repayment of any loan or mortgage 22. If there are more than one of us, then we agree and
account to assist in statistical research relating to credit understand that our liabilities and obligations hereunder
scoring or the investigation and resolution of complaints. are joint and several and we consent to the Lender
I/We understand that this information will be obtained sending all communications and statements of account to
from the new Lender and I/we consent to the Company one only of us unless we otherwise notify the Lender in
using my/our data in this way. writing.
15. Where a financial association has been stated: 23. We understand if the loan is made to joint applicants
‘For Sole Applicants’ each of us will be liable to the Lender for the full amount
of the loan.
Information held about you by the Credit Reference
Agencies may be linked to records relating to your partner. 24. I/We understand that the Lender reserves the right to
For the purposes of this application you and your partner revalue the property at any time after completion of the
are financially independent and you request that your mortgage and, if necessary, reschedule the loan accordingly.
application be assessed without reference to any 25. Neither the Lender or its agents, nor the qualified
‘associated’ records, although you recognise that this may valuer who is to be instructed are under any liability either
adversely affect the outcome of your application. You on the basis of negligence or on any other basis
believe that there is no information relating to your whatsoever to me/us as purchasers in respect of the value
partner that is likely to affect our willingness to offer or the state or condition of the property. The inspection of
financial services to you. You authorise us to check the the property will be carried out on behalf of the Lender
validity of this declaration with Credit Reference Agencies and will not include a detailed survey of the structure
and if we discover any associated records, which would unless specifically requested. I/We understand that the
affect the accuracy of this declaration we may decide not Lender is not the agent of the valuer and I/we understand
to proceed with the application on this basis. that neither the Lender or its agents, nor the valuers will
However, for the purpose of this application you may be warrant, represent, or give any assurance to me/us that the
treated as financially linked and if you wish for your statements, conclusions and opinions expressed or
application to be assessed with reference to any implied in the report and mortgage valuation are accurate
‘associated records’, please tick this box: or valid and that the report will be supplied without any
acceptance of responsibility on their part to me/us.
‘For Joint Applicants’
26. I/We understand that the Lender’s willingness to make
An ‘association’ between the joint applicants and/or any an advance does not imply any representation about the
individual identified as your financial partner, will be created value or condition of the property. I/We understand that
at Credit Reference Agencies, which will link your financial the Lender’s valuation is not carried out for my/our benefit
records. You and anyone else with whom you have a and confirm that I/we have not relied on it.
financial link understand that each others information will
be taken into account in all future applications by either or
both of you. This linking will continue until one of you
Y O U R H O M E M AY B E R E P O S S E S S E D I F Y O U D O N O T K E E P U P R E PAY M E N T S O N Y O U R M O R T G A G E
27. I/We acknowledge that the Lender is entitled to make valuer has been instructed, the application fee will be
such arrangements as they think fit with third parties to refunded net of these costs. I/We further acknowledge
protect themselves against any failure by me/us to pay the that once a valuer has been instructed, no refund of the
mortgage loan, and that such arrangements will be for the application fee can be allowed unless otherwise stated in
Lenders’ benefit and not mine/ours. I/We authorise the the product guidelines.
Lender or its agents to obtain such references or 38. I/We authorise the Lender or the insurers to make
information as the Lender or its agents may deem any enquiries they believe necessary in connection with
necessary for purposes of confirmation, credit assessment the arranging of buildings insurance cover and/or contents
and credit scoring from my/our employer[s], banker[s], cover and/or mortgage indemnity
accountants, previous mortgage lender[s], landlords, credit
reference agencies, government bodies or such other 39. I/We understand that the Lender or its agents will pass
parties as the Lender may consider appropriate. the information on this form and about any incident I/we
may give details of to IDS Ltd. so that they can make it
28. I/We acknowledge that the Lender and their available to other insurers. I/We understand that, in
successors in title and assigns any firm to whom the loan response to any searches the Lender or its agents make in
may be securitised to may in due course raise finance on connection with this application or any incident I/We have
any mortgage they may make to me/us and may: given details of, IDS Ltd. may pass the Lender or its agents
a] transfer, assign, securitise or otherwise dispose of the information it has received from other insurers about
benefits of such mortgage together with policies of life other incidents involving anyone insured under the policy.
assurance and other related security securing it and I/we 40. Save as I/we may have disclosed in this application,
hereby consent to each such transfer or assignment; I/we confirm that:
b] enter into any contractual arrangements relating to the a] I/we have not; and
funding of such mortgage with any person or Lender;
b] I am/we are not aware that any of my/our family
c] pass any information contained in this application and [permanently residing with me/us] or any joint purchasers
any supporting documentation which may hereafter be of the property have been cautioned, convicted of, or
provided or any other information relating to the property, have any prosecution pending for any criminal offence
the mortgage, the security for the mortgage or the history [other than a driving offence]. I/We acknowledge that
and conduct of my/our account to any interested or convictions regarded as “spent” under the Rehabilitation of
potentially interested person, who may rely upon the truth Offenders Act 1974 need not be disclosed.
and accuracy of the information contained in this
application. 41. Unless otherwise agreed with the Lender, I/we
undertake not to let the property without the prior
29. If interest payments are collected from an account written consent of the Lender.
which is not in the names of all borrowers, the payment
will be made for and on behalf of all joint borrowers 42. I/We have not arranged any other loan, second
named on this application. mortgage or improvement grant in connection with the
property.
30. I/We hereby authorise the Lender or its agents to
provide information relating to interest payments on the 43. No loans exist which are required to be, but are not,
mortgage account to the accountant detailed in this disclosed in this mortgage application.
application form and my/our accountant to provide 44. I/We certify that my/our income[s] are sufficient to
information relating to any matter stated in this mortgage meet the payments upon the mortgage that I am/we are
application to the Lender or its agents. applying for.
31. I/We hereby consent to the Lender or its agents 45. I/We will pay the costs incurred by the Lender in
forwarding statements of account, or other such dealing with the application whether or not the loan is
communication to one or all of the borrowers and not to completed.
each borrower individually. 46. The Lender shall be entitled to withdraw any offer of
32. I/We hereby authorise my/our solicitor to disclose to advance at any time before completion of the mortgage
the Lender or its agents any information relevant to their without explanation.
decision to lend and that I/we waive any right to claim 47. Where this application has been introduced by a third
solicitor/client confidentiality or legal privilege in respect of party, that party is not an agent of the Lender and does
such information. not have the authority to commit the Lender to any
33. I/We accept that information given in this application, binding agreement.
and any other information that I/we or my/our agents 48. I/We understand that Creative Mortgage Solutions is
provide to the Lender or is otherwise held by the Lender not an agent of the Lender and does not have any
on me/us may be held on the computer and retained authority to commit the Lender to any binding agreement.
after my/our account is closed and may be shared with
the Lender or its agents to protect its customer against 49. I/We agree to be bound by and abide by the rules of
fraud. the Lender.
34. I/We acknowledge that the Lender or its agents may 50. I/We undertake to notify the Lender of any material
pass to third parties, with whom they make arrangements change in my/our circumstances which does or may affect
to protect themselves against any failure by me/us to pay the information herein, prior to any loans being made.
the mortgage loan, any information contained in this 51. All property insurance claims over a certain sum
application and this application itself together with any [currently £5,000] will be paid through the Lender on
relevant supporting documentation to such third parties. satisfactory evidence of restitution of the property.
35. From time to time the Lender may wish to contact 52. I/We consent to the Lender providing their acting
you regarding other products and services that may be of Solicitors with the mortgage application form or a copy
interest to you. By ticking this box I/we agree to thereof.
receive details of products and services offered by the 53. I/We declare that the property will be used as my/our
Lender by mail, telephone, e-mail or fax.I/We understand sole main residence and no part will be used for business
that if I/we do not wish to receive further information purposes. I/We further undertake not to enter into any
regarding such services and products I/we may write to letting arrangements without the prior consent of the
the Lender and its records will be amended accordingly. Lender.
36. I/We accept that my/our name[s] and address[es] may 54. Loans must be secured on a first mortgage on a
be disclosed to market research organisations for the residential property in England, Wales, Northern Ireland or
purpose of confidential market research on behalf of the mainland Scotland.
Lender or its agents.
55. I/We understand that any telephone calls and e-mails
37. I/We acknowledge that part of the application fee paid to do with my/our application or mortgage may be
at outset defrays the cost of initial assessment of my/our recorded and monitored for security, quality and/or
loan application and that, in the event that my/our loan training purposes.
application is declined or does not proceed before the
Y O U R H O M E M AY B E R E P O S S E S S E D I F Y O U D O N O T K E E P U P R E PAY M E N T S O N Y O U R M O R T G A G E
IMPORTANT: The Lender will consider your mortgage circumstances where such disclosure is necessary,
application based on the mortgage product you have including my/our insurers and the Lender’s insurers [if any],
selected and the information we supply to you before any the mortgage broker, valuer or solicitor, or other agent
advance is made will relate to this product only. who introduced me/us, any sub-contractors and agents of
56. I/We confirm that I/we are complying with the terms the Lender and any Lender for whom the Lender may be
of business set out on the Lender’s website. acting as agent and any other person having a legal right to
the information. I/We understand that the Lender will keep
57. I/We acknowledge the way an interest only mortgage this information confidential and it will only be shown to
works and that the balance of my/our mortgage will not other parties in limited circumstances, namely; if it has to
reduce over the term of mortgage and it will be my do so by law; it is in the public interest or the Lender’s
responsibility to repay the loan from other sources at interest to do so; the recipient is another member of the
maturity of the loan. [This applies only to applicants who Lender’s group; or if I/we have given our permission.
are taking out an interest only mortgage].
66. I / We understand that Creative Mortgage Solutions
58. I/We understand that an ‘Introducer Certificate’ must will carry out an identification check on me/us and that
be fully completed and attached to every application to the agency who Creative Mortgage Solutions will instruct
support the ‘Know Your Customer’ information which has to carry out this check and who supply to Creative
been collected from myself/ourselves. Mortgage Solutions with the results will record details of
59. I/We agree that details relating to this application and the check whether or not my / our application proceeds.
my account with you once any mortgage commences, 67. I / We understand that the lender may out source the
can be provided to the FSA to assist them in monitoring administration of my / our mortgage account to a third
compliance. party. I /We authorise the lender to give, send and receive
60. I/We confirm that the declarations contained in this information and personal data to / from any such third
application form shall continue in full force and effect party for the purpose of administering my / our mortgage
notwithstanding the completion of any mortgage. account.
61. I/We will make all payments by direct debit. I/We 68. I / We authorise Creative Mortgage Solutions to
understand that the amount I/we pay each month may instruct a provider of valuations to carry out a property
change or the date that I/we make my/our monthly valuation at my / our cost for Creative Mortgage Solution's
payments may change and that in either case the Lender purposes and understand that subsequently any valuation
will give me/us notice in writing before this happens. On report will not be made available to me / us. In certain
this basis I/we waive the normal fourteen days BACS circumstances, and for the certain lenders, I/we
notice requirement. I/We accept any arrangements made understand that the valuation of the property may be
by the Lender for any buildings insurance and authorise assessed using statistical information, and in these
the deduction of monthly insurance premiums to be circumstances, a qualified valuer or provider of valuations
included in the monthly direct debit payable to the will not physically visit the property.
Lender. 69. I / We understand that no liability whatsoever extends
62. I/We confirm that I/we have been made aware of any to me / us in respect of the value or the condition of the
potential arrangement fees, and/or early repayment property.
charges payable on redeeming all or part of the mortgage 70. I / We agree that the lender may, without notice,
and any other costs in connection with this application. transfer or assign, either in whole or in part any loan,
63. I/We have received and read the Initial Disclosure mortgage or security for the repayment of any loan or
Document [IDD] and the Key Facts Illustration [KFI] mortgage made in connection with this application to its
provided to me/us by my/our mortgage intermediary in successors and assigns which include, without limitation, its
respect of this mortgage application. legal and equitable assigns whether by way of absolute
64. I/We agree that where I/we borrow or may borrow assignment or by way of security only and those deriving
from the Lender, the Lender may give details of my/our title under it or them. I/We understand that the lender
account and how I/we manage it to Credit Reference may provide details of my/our account to prospective
Agencies. If I/we borrow and do not repay in full and on successors and/or assigns in order that they may conduct
time, the Lender may tell Credit Reference Agencies who due diligence checks prior to any transfer taking place.
will record the outstanding debt. I/We understand that such checks may involve my/our
personal data being passed to third parties, including, but
65. I/We authorise the Lender to disclose information not limited to, credit reference agencies for the purpose
relating to this application and any agreement entered into of quality analysis.
as a result of this application to all persons in the limited
Fee deductions
I/We authorise you to deduct the following fees from the total loan on completion
Telegraph transfer fee Completion fee
Local Authority search indemnity fee [remortgage only] Title insurance fee
Other [please specify]
I/We understand that if I/we are found to have made any false statements or not fully disclosed any information required by
this form then this can result in my/our application being declined, any offer issued being cancelled by the lender [even if
contracts have been exchanged] and any loss of fees I/we have paid to date.
Ist Applicant Signature Date 2nd Applicant Signature Date
Y O U R H O M E M AY B E R E P O S S E S S E D I F Y O U D O N O T K E E P U P R E PAY M E N T S O N Y O U R M O R T G A G E
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