| Intermediary Use Only |
|
| Intermediary |
|
| Contact
Name |
|
| FSA: are you |
A directly authorised firm or individual
An appointed representative
An authorised network
Non-authorised
|
| Network |
|
| FSA Number (if
applicable/available) |
|
| Telephone |
|
| Fax |
|
| Email |
|
| Mobile |
|
| <%Response.Write(Lender(1,14)) %>
to contact client direct ?
|
Yes
No
|
|
| Authority |
| Please
confirm that the applicant has given authority for the
intermediary to supply the information requested below to
<%Response.Write(Lender(1,14)) %>
and the release of this information to any other third party
connected with this introduction or placement of the
transaction.
|
Yes
No |
Verbally
In Writing |
| We may
need to undertake a credit search, record information,
disclose information as necessary to negotiate terms with a
funding source and disclose information if required to do so
by law, please confirm that the applicant has given authority
for us to do so.
|
Yes
No |
Verbally
In Writing |
|
| Applicant Details |
| Is the
Applicant |
| A limited Company - |
Company Name
|
|
Directors Names (if Ltd Company)
|
| A Sole Trader - |
Trading Name
|
| A Partnership - |
Trading Name
|
|
Is this a Limited Liability Partnership ?
Yes No |
|
Names of Partners
|
| Trade/Business
Type |
|
| Does the
Applicant or related person (spouse, common law partner,
parent, sibling, child, grandchild, grandparent) dwell or
intend to dwell at part of the property offered as security
?
|
| Yes
No |
| If Yes,
does this part exceed 40% of the total security area ?
| Yes
No |
|
|
| Applicant/Director/Partner 1 |
|
Mr
Mrs
Miss
Ms
|
| First Name |
|
| Surname |
|
| Applicant/Director/Partner 2 |
|
Mr
Mrs
Miss
Ms
|
| First Name |
|
| Surname |
|
| Applicant/Director/Partner 3 |
|
Mr
Mrs
Miss
Ms
|
| First Name |
|
| Surname |
|
| Applicant/Director/Partner 4 |
|
Mr
Mrs
Miss
Ms
|
| First Name |
|
| Surname |
|
| Correspondence Address |
|
| Postcode |
|
| Email |
|
| Telephone |
| Home |
|
| Work |
|
| Mobile |
|
| Fax |
|
|
| Financial Information |
| Income Evidence: |
| Please tick only one of the
boxes and provide corresponding details |
| 1 years audited accounts |
|
|
If yes
Net profit (£)
Depreciation
(£)
Finance Costs (£)
We will require sight of the audit accounts to verify the trading reconstituted profits.
|
| Management accounts |
|
| Annual Rental Income (£) |
|
| Self declaration |
|
| Employed Income (£) |
|
| |
|
|
| Credit Status: |
| Any
Existing CCJs
| Yes
No |
|
If Yes, number of unsatisfied CCJs in the past 2 years
|
|
| Value (£) | |
| Any
arrears in the last 12 months
| Yes
No |
| If Yes, highest arrears in the past 12 months (remortgages only) (£) |
|
|
Previous Bankruptcy
| Yes
No |
| If Yes, when was it discharged ? |
|
| IVA
| None
Completed over 2 years
Completed over 1 year
Current & satisfactory
|
| CVA
| None
Completed over 2 yrs
Completed over 1 yrs
Current & satisfactory
|
|
| Mortgage Required |
| Commercial Mortgage
Required (£) |
|
| Term |
Years |
| Or |
|
Maximum Term Required
|
| Purpose of
Loan |
|
| Address
of Property Offered as Primary Security |
|
| Postcode |
|
| Brief
Description of Property |
|
| Tenure of
Security -
| Freehold
Feuhold
Leasehold
|
| Years Remaining on
Lease (if applicable) |
|
|
| Where Property Already Owned - |
| Date Purchased dd/mm/yyyy |
// |
| Purchase Price (£) |
|
| Current Value
(£) |
|
| Amount of
Outstanding Mortgage/Charge (£) |
|
| Name of Lender
|
|
|
| Where Property To Be Purchased - |
| Purchase Price
(£) |
|
| Does The Purchase Price Include |
Fixtures & Fittings
Value(£)
Goodwill
Value(£)
Stock
Value(£)
|
| Current Value
(£) |
|
|
| Investment Property |
| Lease Start Date dd/mm/yyyy |
// |
| Term |
|
| Current Annual Rent £ |
|
| Next rent review dd/mm/yyyy |
// |
| Name(s) of tenant(s) if known |
|
|
| Further Information |
|
|
|
|
