Intermediary Data Capture Form. October Version /DW/65074JAV

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1 Intermediary Data Capture Form October 2014 Version /DW/65074JAV

2 Submission details. Version 2 What level of advice is being provided Advised Non advised Is the Application being submitted via a Mortgage Club Mortgage Club Submission details. Number of Applicants Type of Applicant Personal Limited company About the loan. Purpose of loan Purchase Remortgage* First time buyer Estimated value/purchase price Will the property be occupied by the applicant or their immediate family? *If Remortgage Capital raising purpose Loan amount Anticipated monthly rental income Does the applicant require any additional borrowing over and above their current mortgage? Yes* No Mortgage Term years Repayment type Interest Only Capital Repayment Part/Part* *If Part/Part Interest only amount Source of deposit Builder incentive Vendor incentive Tenants incentive scheme Gifted Family Gifted Other Equity Saving Additional borrowing Other *If Yes Purpose of additional borrowing Car Purchase Debt Consolidation Gambling Debt Holiday Home Improvements Pay Tax Other: 2 14

3 About the Limited Company (if applicable). Limited company name Is the registered address the same as the correspondence address Registered number Correspondence address Date of incorporation Limited company address Applicant Role within business % Shareholding Applicant 3 Applicant

4 About the Applicants. Title Mr Mrs Miss Ms Dr Title Mr Mrs Miss Ms Dr First name First name Middles name(s) Middles name(s) Surname Surname Date of birth Date of birth Anticipated/Actual retirement age Anticipated/Actual retirement age Nationality Nationality Right to reside in the UK Length of residency in the UK years months from birth Right to reside in the UK Length of residency in the UK years months from birth Time with bank years months Time with bank years months Marital status Single Married Separated Divorced Widow Civil Partnership Marital status Single Married Separated Divorced Widow Civil Partnership Home telephone number Home telephone number Work telephone number Work telephone number Mobile telephone number National insurance number (Required for DIP) Has the applicant been known by any other name in the last 6 years? Yes* No *If yes Previous title Mr Mrs Miss Ms Dr Mobile telephone number National insurance number (Required for DIP) Has the applicant been known by any other name in the last 6 years? Yes* No *If yes Previous title Mr Mrs Miss Ms Dr Previous first name Previous first name Previous middle name(s) Previous middle name(s) Previous surname Previous surname 4 14

5 Residential address details. Current address Current address Residential status Residential status Owner - Mortgaged* Owner - Unencumbered Owner - Mortgaged* Owner - Unencumbered Renting - Privately Renting - Local Authority/ Housing Association Renting - Privately Renting - Local Authority/ Housing Association Living with family/friends Tied Accommodation Living with family/friends Tied Accommodation From to If current address is less than 3 years ago From to If current address is less than 3 years ago Previous address Previous address Previous Residential status Previous Residential status Owner - Mortgaged* Owner - Unencumbered Owner - Mortgaged* Owner - Unencumbered Renting - Privately Renting - Local Authority/ Housing Association Renting - Privately Renting - Local Authority/ Housing Association Living with family/friends Tied Accommodation Living with family/friends Tied Accommodation From to From to *If Owner Mortgaged Will the current mortgage be redeemed on completion * *If no Reason for not redeeming on completion Name of current lender *If Owner Mortgaged Will the current mortgage be redeemed on completion * *If no Reason for not redeeming on completion Name of current lender 5 14

6 Employment status. Self employed partnership Fixed Term contract Self employed partnership Fixed Term contract Limited Company Director Sub Contractor Limited Company Director Sub Contractor You will need to supply the following documents: Employment Pay Slip Bank Statement SA302 Other 3 months 3 months -- P60 (If required ) Fixed Term Contractor 3 months 3 months -- P60 (If required ) Self (Sole Trader) -- 6 months Latest -- Self (Partnership) -- 6 months Latest -- Sub-Contractor 3 months 3 months Ltd. Co. Director -- 6 months Latest months Latest Pension Statement If, Fixed Term Contract or Sub Contractors. Full time Full time Start date Start date Is the position permanent Is the contract likely to be renewed Is the position permanent Is the contract likely to be renewed Current contract end date Current contract end date Income Basic Salary Income Basic Salary Allowance Allowance Overtime Overtime Commission Commission Bonus Bonus Dividend Income Dividend Income 6 14

7 If, Fixed Term Contract or Sub Contractors continued. Place of work Place of work Company postcode Company postcode If current employment is less than 3 years ago Job 1 Self employed partnership Fixed Term contract Limited Company Director Sub Contractor If current employment is less than 3 years ago Job 1 Self employed partnership Fixed Term contract Limited Company Director Sub Contractor Start date End date Start date End date Job 2 Job 2 Self employed partnership Fixed Term contract Self employed partnership Fixed Term contract Limited Company Director Sub Contractor Limited Company Director Sub Contractor Start date End date Start date End date 7 14

8 Secondary Employment. Self employed partnership Fixed Term contract Self employed partnership Fixed Term contract Limited Company Director Sub Contractor Limited Company Director Sub Contractor Employment details Full time Part time Employment details Full time Part time Start date Start date Is the position permanent Income Basic Salary Allowance Overtime Commission Bonus Dividend Income Is the position permanent Income Basic Salary Allowance Overtime Commission Bonus Dividend Income Latest year Latest year Previous Previous Company address Company address Company postcode Company postcode If. Pension Income (Gross annual amount) _ Service Widows Occupational Other Pension Income (Gross annual amount) _ Service Widows Occupational Other 8 14

9 If Self employed or Limited Company Director. Accountant used Accountant contact name Accountant used Accountant contact name Accountant address Accountant address Accountant telephone number Accountant telephone number Accountant address Accountant address Nature of business Nature of business Date commenced trading Date commenced trading Basic Salary Basic Salary Allowance Allowance Overtime Overtime Commission Commission Bonus Bonus Dividend Income: Dividend Income: Percentage of business owned % Net Profit / Dividends Year ending y y y y (most recent year first) Year ending y y y y Percentage of business owned % Net Profit / Dividends Year ending y y y y (most recent year first) Year ending y y y y Company address Company address Company postcode Company postcode 9 14

10 Income. Are any of the declared incomes likely to reduce within the foreseeable future Are any of the declared incomes likely to reduce within the foreseeable future Property Portfolio. Total number of properties Total number of properties Estimated value of property Estimated value of property Total outstanding balance of mortgages Total outstanding balance of mortgages Total monthly portfolio rental income Total monthly portfolio rental income Total monthly portfolio mortgage payments Total monthly portfolio mortgage payments 10 14

11 Adverse details. Has the applicant ever been in arrears Mortgage Credit card Unsecured loan Secured loan Hire purchase Has the applicant ever been in arrears Mortgage Credit card Unsecured loan Secured loan Hire purchase Highest number of missed payments in last 3 years Has the applicant ever had a default registered Date Registered Amount Date Satisfied Highest number of missed payments in last 3 years Has the applicant ever had a default registered Date Registered Amount Date Satisfied Has the applicant ever had a County Court Judgment registered Date Registered Amount Date Satisfied Has the applicant ever had a County Court Judgment registered Date Registered Amount Date Satisfied Has the applicant ever been subject to an individual voluntary arrangement Date of IVA Date Satisfied Has the applicant ever been subject to an individual voluntary arrangement Date of IVA Date Satisfied Has the applicant ever been made bankrupt Date of bankruptcy order Date bankruptcy discharged Has the applicant ever been made bankrupt Date of bankruptcy order Date bankruptcy discharged Has the applicant ever had a property repossessed Date of repossession Has the applicant ever had a property repossessed Date of repossession Has the applicant at anytime had a criminal conviction Has the applicant at anytime had a criminal conviction Conviction Type Conviction Type Conditional Discharge Probationary Orders Conditional Discharge Probationary Orders Fine Compensation Order Fine Compensation Order Community License Prison Sentence Community License Prison Sentence Date of conviction Date of conviction 11 14

12 About the property. Has the applicant already found a property Type of sale Property address If Re-mortgage Date of original purchase Purchasing from Builder Purchasing from Landlord or Sitting tenant Purchasing from relative Via estate agent Direct from Vendor Private sale from/to company Tenure Freehold Leasehold* Commonhold Flying Freehold % Former Feudal Property description House Bungalow Flat/Maisonette Purpose Built House converted to flats Bedsit Studio Flat Flat/Maisonette Converted HMO Other Property type Detached Semi Detached End Terraced Mid terraced Other No of storeys in building Floor which flat is situated Basement Ground Floor Mezzanie Floor Number Does the building have a lift Is the property a new build or converted in the last 12 months Year of construction Certificate type y y y y (NHBC Zurich etc) Is property of standard construction *If Leasehold Number of years remaining on lease Is the property connected to or above a commercial property Yes No Is any of the property to be used for business purposes Yes No Percentage of property used for business % Was the property owned by the Local Authority Yes No Is the applicant buying the property directly from the Local Authority Yes No Is the property subject to agricultural restrictions Yes No Does the property include more than 3 acres of land Yes* No Number of bedrooms Number of kitchens Number of reception rooms Number of bathrooms Number of garages *If Yes Number of acres 12 14

13 Product details. Product Product term years Product type Fixed Tracker Product rate % Intermediary fees. Are any intermediary fees payable for this application Type When payable Application Offer Completion Amount Refundable amount Lender fees. Completion fee added to the loan Telegraphic transfer fee added to the loan Property contact details. Vendor name Telephone number Contact for valuation Vendor Applicant Selling agent Other Is there a selling agent involved in this transaction Yes No Contact name Selling agents name Contact telephone number Contact name Additional access information Telephone number 13 14

14 Solicitor details. Fleet mortgages operates a restricted panel of solicitors, please refer to our approved panel of solicitors. Solicitor company name Solicitor contact name Address Bank details. The following circumstances are acceptable: A mandate drawn on the applicant(s) personal account. Where the application is in the name of a Limited Company, a mandate drawn on the Limited Company or guarantor(s) account. The following circumstances are unacceptable: A mandate drawn on a personal account solely in the name of a non-borrowing individual. A mandate drawn on a business account for a non-borrowing individual. Sort code Account number Bank name Address A signed direct debit mandate must be received prior to ompletion. Account holder name Additional information relevant to the application. _ 14 14

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