APPLICATION SUMMARY DATA CAPTURE ONLY Applicant Name: Section 1 - Intermediary Details Broker First Name Broker Surname FCA Number Telephone Number Level of Advice Packaged Application Packager Name Packager Telephone Number Submitted via Mortgage Club Mortgage Club Name Mortgage Club Telephone Number Section 2 - Applicant(s) Details Title: Forename: Middle Name: Surname: Gender: Date of Birth: Retirement Age: Right to reside in UK Nationality: Length of Residency in UK: Martial Status: UK Citizen: First Time Landlord: National Insurance No: Preferred Contact Method: Home Telephone No: Work Telephone No: Mobile Telephone No: Email Previous Names Title: Forename: Middle Name: Surname: ACC 1543 Page 1 of 6 15/12/14
Section 2 - Applicant(s) Details Continued Current Bank Account Sort Code: Account Number: Bank Name: Bank Account Holder Name: Length of Time With Bank: Years Months Years Months Current Address Residential Status: Time at Years Months Years Months Previous Address Residential Status: Time at Landlord Details for Current Address Name of Landlord: Years Months Years Months Date Tenancy Commenced: Amount of Rent being paid: Section 3 - Employment Details Employment Status: Full / Part Time: Occupation: Job Title / Position: Date Start Employment: Date End Employment: Share Percentage: Is Director?: Basic Salary: Company Name: Payroll Number: Payment Frequency: Telephone No: Department: Page 2 of 6
Section 3 - Employment Details Continued Income Details Area Allowance: Car Allowance: Shift Allowance: Regular Overtime: Regular Bonus: Regular Commission: Mortgage/Housing Allowance: HR Details HR Contact Name: Telephone No: Self Employed Full / Part Time: Occupation: Job Title: Nature of Business: Business Telephone No: Start Date: End Date: Length Self employed: Business Name: VAT No: Tax Office Name: Tax Reference: Employment Percentage shareholding: % % Net Profit Share: Business Name: Accountant Details Name: Telephone No: Qualification: How Long has the accountant acted for the applicant(s)? Accountant Year Year Page 3 of 6
Section 3 - Employment Details Continued Other Income Details Area Allowance: Car Allowance: Shift Allowance: Regular Overtime: Regular Bonus: Regular Commission: Mortgage/Housing Allowance: Retirement Income Details Income Type: Gross Annual Amount: Start Date: End Date: Previous Employment Employment Type: Job Title: Employed Date (from): Employed Date (to): Section 4 - Current Mortgage & BTL Commitments Note: All current BTL s including those which are unencumbered will need to be input when submitting Online. Type: Mortgage Provider: Account No: Purchase Date: Date Mortgaged Commenced: Balance Outstanding: Current Monthly Payment: Shared with Joint Applicant: Gross Rent Received: Rental voids in the last 12 months: Loan to be repaid on completion of mortgage? What was the purpose of the above Mortgage? Section 5 - Financial Commitments Note: All Commitments must be declared when submitting the application Online. Type: Provider: Account No: Balance Outstanding: Monthly Payment Shared with Joint Applicant: Time left to run (in months): Months Months Page 4 of 6
Section 6 - Applicant Adverse Details Arrears Has the Applicant ever been behind with any financial commitments: YES NO YES NO Commitment Type: Total No of missed payments in last 24 months: Defaults Has the Applicant ever had a default registered against them?: Date Default Registered: Default Amount: County Court Judgments Has the Applicant ever had a County Court Judgement against them?: Date CCJ Registered: CCJ Amount: Individual Voluntary Arrangements Has the Applicant ever been subject to an individual voluntary arrangement?: Date of IVA: Date IVA Satisfied: Bankruptcies Has the Applicant ever been made bankrupt?: Date of Bankrupt Order: Date of Bankruptcy Discharged: Repossession Has the Applicant ever been made repossessed?: Date of Repossession: Section 7 - Loan Details Loan Purpose: Type of Loan: Estimated Value / Purchase Price: Advance Request: Term: Repayment Type: Source of Deposit Amount of Deposit Purpose of Funds Amount of Funds: Cashback / Incentives Amount Section 8 - Security Details Property Details Property Property Description: Property Type: Number of Bedrooms: Number of Bathrooms: Number of Reception Rooms: Page 5 of 6
Section 8 - Security Details Continued Monthly Rental Income Year Property Built: Tenure: Remaining Lease: Number of floors in block: Floor upon which flat is located: Ex-Local authority: Ex-Ministry of Defence: Above Commercial Property: Will agent manage Property: Purchase Type: Is Property currently Let?: How many people reside there?: Will the tenants remain?: Name of Tenants?: Term of Tenancy (months)?: Vendor Details Name: Telephone Number: Is applicant related to the vendor: Does the applicant(s) have a business relationship with the vendor?: Valuation Type Valuation Type: Arrangement to Access the Property Details Contact Type: Name: Telephone Number: Additional Information which will help the valuer to gain access: Section 9 - Solicitor Details Appointed Solicitor Solicitor Contact Name: Firm Name: Telephone Number: Fax Number: Email DX Number: Solicitor Section 10 - Direct Debit Details Is the Account in the name of at least one of the applicants? Sort Code: Account Number: Bank Name: Bank Account Holder Name: Preferred Payment Date: Accord Mortgages Limited is authorised and regulated by the Financial Conduct Authority. Accord Mortgages Limited is entered in the Financial Services Register under registration number 305936. Buy to Let Mortgages are not regulated by the Financial Conduct Authority. Accord Mortgages Limited is registered in England No: 2139881. Registered Office: Yorkshire House, Yorkshire Drive, Bradford BD5 8LJ. Accord Mortgages is a registered Trade Mark of Accord Mortgages Limited. Page 6 of 6