Get documents about "MORTGAGE SECURED LOANS INFORMATION SHEET
Document Sample
HIA1 (v.2) Private and Confidential
Please return this form to:
Area Renewal, H.I.A. Unit
2-5 Limewood Approach
Seacroft
Health & Environmental Leeds
Action Service LS14 1NG
Home Improvement Assistance
Initial Enquiry Form
PLEASE ANSWER QUESTIONS IN CAPITAL LETTERS
OR CIRCLE THE RELEVANT ANSWERS.
1. Loan Details
Please read the accompanying leaflet before answering the following question :-
Would you be interested in applying for a loan from the Council to fund any of the work you wish to carry out, if no
other form of financial assistance was available? YES NO
2. Address Details
Address of property at which the works are to be carried out: Address for correspondence (if different):
Postcode: Postcode:
Home Telephone Number:
Work/Mobile Telephone Number: E-mail Address:
3. Ownership Details
Are you or will you be: OWNER OCCUPIER PRIVATE TENANT
OTHER (Please specify) ________________________________
Are you or will you be a joint owner? YES NO
If YES, give the name(s) and address(es) of those people with a joint interest in the property:-
4. Occupier Details
Please give details about yourself, your partner and anyone else who lives with you.
Date of What do you/they do?
Full Name Age
Birth (e.g. unemployed, work, student, retired)
MR MRS MISS MS.
(APPLICANT)
MR MRS MISS MS.
(PARTNER)
What do they do?
Other people who live Date of Relationship
Age (e.g. school, unemployed, work,
with you Birth to applicant
student, retired)
5. Benefits Details
Are you or any of the applicants in receipt of any of the following (please circle as appropriate):
Income Support
Guaranteed Pension Credit
Income Based Job Seekers Allowance
Council Tax Benefit (not single person discount)
Housing Benefit
Working Tax Credit (income limits apply)
Child Tax Credit (income limits apply)
Disability Living Allowance
Attendance Allowance
Industrial Injuries Disablement Benefit
War Disablement Pension
When returning this form please include proof of your relevant benefits, if Tax Credits are received
the full notification letter will be required (photocopies are acceptable). If you have difficulty finding
your benefit documents or obtaining copies, please telephone us for advice –
PROOFS MUST BE PROVIDED OR WE CANNOT ASSESS YOUR APPLICATION.
6. Property Details
When did you buy the property? ____________________
What Council Tax Band is your property in? A B C D E F G H DON’T KNOW
What is the approximate value of your property? £____________________
Do you have a mortgage? YES NO
What type of Mortgage do you have? REPAYMENT ENDOWMENT INTEREST ONLY
Mortgage Start Date: ____________________ Original Amount Borrowed: £____________________
Any Further Borrowing (on Mortgage)? YES NO
Date: ____________________ Amount: £____________________
Do you have up-to date buildings insurance cover? YES NO
If Yes, which company is it with? ____________________________________________________
MORTGAGE DETAILS:
Mortgage Lender Name: _______________________________________________________________________
Account No. : ___________________________________________
Actual Monthly/ Weekly Payment: £___________________ Arrears (if any): £___________________
Approx. Balance Outstanding: £___________________
ENDOWMENT POLICY DETAILS:
Endowment Policy Company Name: ____________________________________________________________
Policy Number: ________________________________________________
Monthly Premiums: £___________________
Is the policy tied to your property? YES NO
Is your Policy? LIVE SURRENDERED LAPSED
You MUST provide a copy of your most recent Mortgage/Endowment statement to
accompany this form.
SECURED LOAN DETAILS:
Secured Lender Name: _______________________________________________________________________
Account No. : __________________________________________
Start Date: __________________ Amount Borrowed: £____________________
Type: REPAYMENT INTEREST ONLY
Purpose: __________________________________________________________________________
Actual Monthly/ Weekly Payment: £____________________ Arrears (if any): _________________
NB: If you have more than 1 Secured Loan, please continue on a separate sheet of paper.
You MUST provide copies of any approved Loan agreement(s) to accompany this form.
7. Repair/Improvement Details
Are the works likely to cost more than approx. £1,000? YES NO
Please give a brief description of what works are required at your property:
8. Declaration and Signatures
Public funds must be protected and so the information you have provided on this form may be used to prevent and
detect fraud.
The information may also be shared, for the same purposes, with other organisations which handle public funds.
I declare that the information I have given is correct and complete. I fully understand that if false information is given this
will result in my enquiry being cancelled or court proceedings possibly being taken to recover any payments made.
I accept that financial assistance will be based on the lowest estimate submitted from my contractors.
I accept that if there are any structural problems with my property that, where relevant, I will contact my
buildings insurance company in the first instance.
Signed (yourself): ...........................................................................................................................................
National Insurance Number: ........................................................................... Date: ........../........../..........
Signed (partner): ...........................................................................................................................................
National Insurance Number: ........................................................................... Date: ........../........../..........
IF YOU FAIL TO PROVIDE ALL RELEVANT SUPPORTING EVIDENCE, IT MAY RESULT IN DELAYS.
FOR OFFICE USE ONLY
I ...................................................................................... have completed this form on behalf of the applicant
and have read all the details over to him/her before asking him/her to sign the declaration.
Signature: ....................................................................................................... Date: ........../........../..........
12/08
