Application Form

Loan Requirements

Loan Amount (Max £25,000)
Loan term Yrs (Max 7)
Loan Purpose
Have you made 3 or more applications for a loan in past month?: yes no

Applicants

Is application single or joint?: single joint

Applicant 1

General Details

Date of Birth:
Title:
First Name:
Middle name(s):
Surname:
No of Dependants:
Nationality:
Marital Status:
Residential Status:
Country of residence:
Telephone (Home):
Telephone (Work):
Telephone (Mobile):
Best number to call:
Best time to call:
Email address:

Employment

3 years history required. Use notes field at bottom if required

Employment type:
Occupation:
Employer:
Time in with employer (yrs & mths):
Hours per week:
Annual Gross Income:
Pay frequency (Weekly/Monthly):
Employers address:

Notes:

Address details

5Yrs history required - use notes field at bottom if necessary

Current address

Flat:
House name:
House no.:
Street:
District:
Town:
Country:
Postcode:
Time at address (Yrs / Mths):

Previous address

If less than 5 years at current address

Previous Address:
Time at address (Yrs / Mths):

Notes:

Mortgage / Rent details

If renting just provide monthly rent and arrears details

Lender:
Balance (£):
Property value (£):
Monthly payment (£):
Endowment premium (if any) (£):
Property type:
Purchase price (£):
Purchase date:
Current arrears (£):
Highest arrears in last 12 months (£):

Bank Details

Account type:
Time with bank Yr/Mth:
Bank:
Cheque guarantee card:: yes no
Switch/Maestro/Delta card:: yes no
Overdraft facility:: yes no
Overdraft Balance/Limit (£):

Applicant 2

General Details

Date of Birth:
Title:
First Name:
Middle name(s):
Surname:
No of Dependants:
Nationality:
Marital Status:
Residential Status:
Country of residence:
Telephone (Home):
Telephone (Work):
Telephone (Mobile):
Best number to call:
Best time to call:
Email address:

Employment

3 years history required. Use notes field at bottom if required

Employment type:
Occupation:
Employer:
Time in with employer (yrs & mths):
Hours per week:
Annual Gross Income:
Pay frequency (Weekly/Monthly):
Employers address:

Notes:

Address details

5Yrs history required - use notes field at bottom if necessary

Current address

Flat:
House name:
House no.:
Street:
District:
Town:
Country:
Postcode:
Time at address (Yrs / Mths):

Previous address

If less than 5 years at current address

Previous Address:
Time at address (Yrs / Mths):

Notes:

Mortgage / Rent details

If renting just provide monthly rent and arrears details

Lender:
Balance (£):
Property value (£):
Monthly payment (£):
Endowment premium (if any) (£):
Property type:
Purchase price (£):
Purchase date:
Current arrears (£):
Highest arrears in last 12 months (£):

Bank Details

Account type:
Time with bank Yr/Mth:
Bank:
Cheque guarantee card:: yes no
Switch/Maestro/Delta card:: yes no
Overdraft facility:: yes no
Overdraft Balance/Limit (£):

Existing credit

Use notes field at bottom if required

Credit type	Lender	Credit Limit £	Balance	Monthly payment	Repay from Loan?

Is any applicant currently on a debt management programme?: yes no
Monthly council tax payment (£):

Notes:

CCJ / Default Details

Type	Amount	Date Registered	Date Settled

Data Protection Act

The following explains what will happen with the information you have provided. The information shall be passed to and used by The Loan Packaging Partnership (LPPL) t/a Independent Specialist Finance, its subsidiaries and associated partners both now and in the future to process this application for a loan and any other financial products that may be suitable. The information may be retained on their computer systems and/or files in accordance with the terms and conditions of the Data Protection Act.

The LPPL and their lending companies will check the information supplied an loan applications with data held by one or more credit reference agencies. The lender may search on more than one occasion. Every time a search is made it is recorded by the credit reference agency and disclosed to other organisations on any later searches. The information will be used by our lenders or other companies for making credit decisions about you and other members of your household, for tracing debtors or for controlling fraud. Some lenders use credit scoring systems to access and approve loan applications. The lending company may also pass the information onto their insurers or to the organisations providing their funding.

If you disclose information about a joint

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John Smith
London, England

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