Consulco Finance. Application Form

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1 Consulco Finance Application Form

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3 1 INTRODUCER DETAILS Full name of Introducer FSA No. Company name Company address Telephone Fax Network/Packager (if applicable) FSA No. 2 LOAN DETAILS Total loan amount required Term required (max 11 months) months Purpose of loan Security offered Proposed exit route 3

4 3 APPLICANT DETAILS 1st Applicant/Director 2nd Applicant/Director Title: Mr/Mrs/Miss/Other Surname Forename(s) Date of birth Dependants How many? Ages How many? Ages Marital status Single Married Single Married Separated Divorced Separated Divorced Living together Widowed Living together Widowed Home address Residential status Homeowner Tenant Homeowner Tenant Living with relatives Other Living with relatives Other Time at this address Years Months Years Months If less than 3 years please give previous address* Residential status Homeowner Tenant Homeowner Tenant Living with relatives Other Living with relatives Other Time at this address Years Months Years Months *If any of the applicants has had more than one previous residence in the past three years, please provide full details of each address on the additional information page. 4

5 4 APPLICANT CONTACT DETAILS 1st Applicant 2nd Applicant Telephone (Home) Telephone (Work) Mobile Fax 5 CORPORATE BORROWER (if applicable) Company or Trust name Jurisdiction registered Company number Date of Incorporation Registered office Postal address Name of Directors Nature of Business 5

6 6 EMPLOYMENT Please complete if you are: 1. Employed or 2. Self-employed 1. EMPLOYED 1st Applicant 2nd Applicant Occupation Employer s name Employer s full address Start date Annual gross salary Other regular income Total monthly income 2. SELF-EMPLOYED Or if you own 25% or more in your employer's business 1st Applicant 2nd Applicant Name of business Nature of business Business address Trading since Annual gross turnover Year ending Year ending (Please start with the most recently completed accounts) Year ending Year ending Net income per annum Year ending Year ending Year ending Year ending Other regular income Please provide details 6

7 7 ASSETS AND LIABILITIES Private residence as above (if applicable) Value Loan outstanding Other property 1. Value Loan outstanding 2. Value Loan outstanding 3. Value Loan outstanding Bank and building society savings Value Other investments Value TOTAL ASSETS Value Please list any outstanding debts including loans you guarantee Current debts and outgoings Monthly payment Name of lender Start date Account number Credit limit or original loan amount Balance currently outstanding Is the loan secured? Yes No 1st or 2nd Applicant Loans, HP and leases Store and credit cards Overdrafts Catalogues Maintenance or CSA Other (please specify) Have you ever 1st Applicant 2nd Applicant been in arrears with your rent, mortgage payments or any other loans? Yes No Yes No had a court judgment made against you? Yes No Yes No been made bankrupt? Yes No Yes No made arrangements with creditors? Yes No Yes No been refused a loan on this or other property? Yes No Yes No If you have answered yes to any of these questions, please provide details on the additional information page 7

8 8 PROPERTY DETAILS Property address Type of property Residential Commercial Leasehold Freehold If Leasehold Unexpired term years Ground rent (pa) Mortgage outstanding Name of current lender 9 PROPERTY DESCRIPTION Is the property of traditional construction? Yes No Year of construction Is the property ex-local authority/housing association? Yes No What is the purchase price or estimated value if you are remortgaging/purchasing at a concessionary price? If there are additional properties that can be provided as security, please provide details on additional information page. 10 OCCUPATION OF PROPERTY OFFERED AS SECURITY Occupation of property offered as security Details of occupier/tenant Terms of tenancy Monthly rent Rent review Break clause 11 BUILDING INSURANCE We require that suitable insurance cover is maintained on any property offered as security. Please confirm that satisfactory insurance cover is in place at the time of application. If insurance cover is NOT YET in place tick this box and we will arrange for an independent quote to be obtained. 8

9 12 SOLICITOR S DETAILS Name of firm Name of professional acting Address Telephone DX No. Fax No. of partners in firm 13 BANK ACCOUNT DETAILS 1st Applicant/Director 2nd Applicant/Director Account name Account number Bank name Bank address Sort code 14 DECLARATION (must be completed in all cases) 1st Applicant/Director 2nd Applicant/Director Have you ever been convicted of any offences Yes No Yes No (other than driving offences)? Have you ever had any insurer decline or cancel insurance / Yes No Yes No or impose special terms? If you have answered "Yes" to either of the above questions, please provide further details 9

10 DATA PROTECTION STATEMENT USE OF YOUR INFORMATION In considering your application we will search your record at a credit reference agency. They will add to your record details of our search and your application and this will be seen by other organisations that make searches. We may use a credit scoring or other automated decision making system when assessing your application. It is important that you give us accurate information. We will check your details with fraud prevention agencies and, if you give us false or inaccurate information and we suspect fraud, we will record this. Your record will be used by to: help make decisions about credit for you and members of your household. trace debtors, recover debt, prevent money laundering and fraud. The credit reference agency and fraud prevention agencies will also use your record for statistical analysis about credit and about insurance and fraud. Fraud prevention agency records will also be shared with other organisations to help make decisions on motor, household, credit, life and other insurance proposals and insurance claims, for you and members of your household. You can obtain a copy of your personal data held by us, and to which you are legally entitled, by applying in writing to the Data Protection Officer, Consulco Finance Ltd, 32 Curzon Street, London W1J 7WS, and pay any fee applicable. You also have the right to access personal records held by credit and fraud agencies; the names and addresses of these agencies will be supplied on request. 1 ST APPLICANT Signature Print name Date 2 ND APPLICANT Signature Print name Date Declaration I/We declare that the information given in this application form is complete and correct. I/We accept the Data Protection statement above in relation to the use of the data on this application form. I/We confirm that for the period of the loan now being applied for I/We and/or family members do not intend to occupy the above property nor do we intend to do so at the end of the loan period. I/We agree to provide Consulco Finance Ltd with any such information they require in connection with this application. By signing this declaration you have read and agreed to the use of your data. WARNING: YOUR PROPERTY MAY BE REPOSESSED IF YOU DO NOT KEEP UP REPAYMENTS ON YOUR LOAN. 10

11 1. CLIENT IDENTIFICATION CHECKLIST We are required to verify your identity and home address before we can proceed with any application. Please complete the details below and return this form together with the relevant identification documents. No single document can be used to verify both name and address. As proof of identification, we will accept any one of the following (please tick) 1st Applicant 2nd Applicant Full current UK passport Full current EU passport Residence permit issued by the Home Office to EU nationals upon sight of own country passport Current UK photocard driving license (full or provisional) with counterpart Current full UK driving licence As proof of address, we will accept any two of the following (please tick) Utility bill (less than 3 months old) Current local authority Council Tax notification Current UK photocard driving licence (full or provisional) with counterpart Current full UK driving licence UK bank, building society or credit card statement (less than 3 months old) UK building society pass book Current mortgage statement from a recognised lender Current Inland Revenue tax coding notification Please either 1. Deliver the original documents to us in person (do not post original documents to us), or 2. Provide us with copy documents (one relating to the applicant's identity and two relating to the applicant's address) by post, which have been checked against originals by a UK solicitor, UK banker or another regulated professional person such as a qualified accountant or an authorised financial adviser/broker. The person certifying the documents should write on the copies ORIGINALS SEEN and mark them with their company stamp, if possible. Their name, address and telephone number should also be shown on the copy documents. 11

12 2. CORPORATE IDENTIFICATION CHECKLIST We are required to verify the identity of the company and the company address before we can proceed with any application. Please complete the details below and return this form together with the relevant identification documents and a letter of authorisation for the broker/intermediary to act on the company s behalf (must be on company headed paper and signed by a current director of the company). Company details Sole trader LLP Partnership PLC Limited Co. Church Charity Club Society Other (please specify) 1st Applicant 2nd Applicant Name Position As proof of company identification, we will accept any one of the following (please tick) Certificate of Incorporation Solicitor s or Accountant s letter Latest annual report and accounts As proof of company address, we will accept any two of the following (please tick) Current mortgage statement Local authority tax notification Bank statement (less than 3 months old) Utility bill (less than 3 months old) Customs excise VAT notification Credit card statement (less than 3 months old) Please either 1. Deliver the original documents to us in person (do not post original documents to us), or 2. Provide us with copy documents (one relating to the company's identity and two relating to the company's address) by post, which have been checked against originals by a UK solicitor, UK banker or another regulated professional person such as a qualified accountant or an authorised financial adviser/broker. The person certifying the documents should write on the copies ORIGINALS SEEN and mark them with their company stamp, if possible. Their name, address and telephone number should also be shown on the copy documents. 12

13 ADDITIONAL INFORMATION 13

14 FOR CONSULCO FINANCE USE Business Development Manager Date Signature 14

15

16 Our offices Central London Office 32 Curzon Street, London W1J 7WS T:+44 (0) North London Office 758 Great Cambridge Rοαd, Enfield EN1 3GN T:+44 (0) (0)

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