Applicant Name:
1st Applicant 2nd Applicant
Section 2 - Applicant(s) Details
APPLICATION SUMMARY
DATA CAPTURE ONLY
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
Title: Forename: Middle Name: Surname: Gender: Date of Birth: Retirement Age: Right to reside in UK Nationality:
Section 1 - Intermediary Details
Length of Residency in UK: Martial Status:
UK Citizen:
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ACC 1543 15/12/14
First Time Landlord: National Insurance No: Preferred Contact Method: Home Telephone No: Work Telephone No: Mobile Telephone No: Email Address: Title: Forename: Middle Name: Surname: Previous Names
1st Applicant 2nd Applicant
Section 2 - Applicant(s) Details Continued
Sort Code: Account Number: Bank Name: Bank Address:
Current Bank Account
Account Holder Name: Length of Time With Bank: Address:
Current Address
Residential Status: Time at Address:
Postcode Postcode
Years Months Years Months
Postcode Postcode
Years Months Years Months
Address:
Previous Address
Residential Status: Time at Address:
Address:
Landlord Details for Current Address
Name of Landlord:
Date Tenancy Commenced: Amount of Rent being paid:
Postcode Postcode
Months Years Months
Years
Postcode
Section 3 - Employment Details
1st Applicant 2nd Applicant
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 3 of 6
Section 3 - Employment Details Continued
Address: 1st Applicant 2nd Applicant Income Details Area Allowance: Car Allowance: Shift Allowance: Regular Overtime: Regular Bonus: Regular Commission: Mortgage/Housing Allowance: HR Contact Name: Telephone No: Address: HR Details Self Employed
Full / Part Time: Occupation: Job Title:
Nature of Business: Business Telephone No: Start Date:
End Date:
Length Self employed: Business Name:
Postcode Postcode
Postcode Postcode
VAT No: Tax Offi ce Name: Tax Reference: Employment Address:
Percentage shareholding: Net Profi t Share: Business Name: Postcode Postcode % % Year Year Postcode Postcode Accountant Details Name: Telephone No: Qualifi cation:
How Long has the accountant acted for the applicant(s)?
Other Income Details Area Allowance: Car Allowance: Shift Allowance: Regular Overtime: Regular Bonus: Regular Commission: Mortgage/Housing Allowance: Page 4 of 6
Section 3 - Employment Details Continued
Income Type: Gross Annual Amount: Start Date:
End Date:
Retirement Income Details
Employment Type: Job Title:
Employed Date (from): Employed Date (to):
Previous Employment 1st Applicant 2nd Applicant Type: Mortgage Provider: Account No: Purchase Date:
Date Mortgaged Commenced: Balance Outstanding:
Section 4 - Current Mortgage & BTL Commitments
Current Monthly Payment:
Note: All current BTL’s including those which are unencumbered will need to be input when submitting Online.
Shared with Joint Applicant: Address:
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?
Type: Provider: Account No: Balance Outstanding:
Shared with Joint Applicant:
Section 5 - Financial Commitments
Time left to run (in months):
Note: All Commitments must be declared when submitting the application Online.
£ £ £ £ £ £ £ £ £ £ £ £ Postcode Postcode £ £ £ £ Months Months Monthly Payment
Page 5 of 6
1st Applicant 2nd Applicant
Has the Applicant ever been behind with any fi nancial commitments:
Commitment Type:
Total No of missed payments in last 24 months:
Section 6 - Applicant Adverse Details
YES NO
Has the Applicant ever had a default registered against them?:
Date Default Registered: Default Amount:
Defaults Arrears
Has the Applicant ever had a County Court Judgement against them?:
Date CCJ Registered: CCJ Amount:
County Court Judgments
Has the Applicant ever been subject to an individual voluntary arrangement?: Date of IVA:
Date IVA Satisfi ed:
Individual Voluntary Arrangements
YES NO YES NO YES NO £ £ YES NO YES NO £ £ YES NO YES NO
Has the Applicant ever been made bankrupt?: Date of Bankrupt Order:
Date of Bankruptcy Discharged:
Bankruptcies
Has the Applicant ever been made repossessed?: Date of Repossession:
Repossession
YES NO YES NO
YES NO YES NO
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 Address: Property Description: Property Type: Number of Bedrooms: Number of Bathrooms: Number of Reception Rooms:
Section 8 - Security Details Continued
Monthly Rental Income Year Property Built:
Remaining Lease: Number of fl oors in block: Floor upon which fl at is located:
Ex-Local authority: Ex-Ministry of Defence:
Tenure:
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)?:
Name: Telephone Number: Is applicant related to the vendor: Does the applicant(s) have a business relationship
with the vendor?: Address:
Vendor Details
Valuation Type:
Name: Telephone Number:
Additional Information which will help the valuer to gain access:
Contact Type:
Valuation Type
Arrangement to Access the Property Details
Section 9 - Solicitor Details
Appointed Solicitor Solicitor Contact Name:
Telephone Number: Fax Number: Email Address: DX Number: Solicitor Address: Firm Name:
Section 10 - Direct Debit Details
Is the Account in the name of at least one of the applicants?
Sort Code: Bank Name: Bank Address:
Account Holder Name: Preferred Payment Date:
Account Number:
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 Offi ce: Yorkshire House, Yorkshire Drive, Bradford BD5 8LJ. Accord Mortgages is a registered Trade Mark of Accord Mortgages Limited.