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Academic year: 2021


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Stage 2 of 2

Please submit this form to:

Self Build Team

Pentland House

8 Lochside Avenue

Edinburgh Park

South Gyle


EH12 9DJ

It is essential that this form is fully completed by the Intermediary.

TNT 065


Your first name Your last name Company name Company address

Company phone number Company fax number Company email address Preferred email address Alternative email address

Company FCA number Intermediary user ID

Broker name (please print name)

Mortgage application number Date signed

Broker signature

Emails sent to and from Halifax are not secure and could be accessed by an unauthorised person. Whilst we take appropriate measures to safeguard information you provide to us, no email can ever be guaranteed secure.

Any email sent by the Halifax will be restricted to a minimum of application number and brief message including what is required to progress the application to the next stage. The Data Protection Act 1998 restricts the amount of information we can disclose in email messages.

I confirm that I am acting on behalf of the applicant(s) and have their permission to access their information.

I confirm that, to the best of my knowledge and belief, the information contained in this application is true.

I confirm that this application is made in line with the Halifax Self Build policy and understand the application will be declined if it becomes evident this application does not meet the Halifax Self Build criteria.

Intermediary information

Broker declaration


Do you currently own the plot? Yes No

Has any or all of the land been gifted? Yes No

Is the land being or has been separated from either surrounding/adjoining land in the applicant’s or their family’s ownership, or a commercial venture owned by the applicant or their family?

Yes No

Cost of buying the land £

Type of dwelling to be constructed Detached bungalow Detached dormer Detached house

Estimated final value of the property £

Re-confirm loan amount £

Applicant 1 Applicant 2

Personal details

Plot address Postcode

Property information

Postcode Postcode Postcode Postcode Title Mr/Mrs/Miss/Ms/Dr/Other Forename 1 – as shown on id

Forename 2 – as shown on id (if applicable) Forename 3 – as shown on id (if applicable) Surname

Current address

Correspondence address

Is the land free of previous dwelling? Yes No

Has build started? Yes No

Builder’s name

If the applicant is the builder what income will they generate whilst the property is £


Please confirm the name of the building standards indemnity scheme provider or whether consultant monitored. Acceptable providers are listed in the new build section of mortgage lending criteria on the Halifax Intermediary Website.

Investment Club Already owned

Housing Assoc. The Coal Authority Builder/ developer Halifax selling as possessor

Who is selling the plot? Normal Local Authority New Town Corporation

Are applicants related to vendor? Where will you live while the property is being constructed?

Will the property be let out once completed?

Completion of property within 2 years ? Will business be carried out at this property?

What is the tenure of the property?

Entry date – Scotland only

Birmingham Midshires –

remortgage details

(only to be completed for remortgage applications) Original purchase price Mortgage account number Outstanding mortgage amount

Please provide details of any improvements you have made to the property (including estimated costs)

Has your home or nearby building been damaged by subsidence, heave, landslip or does it show any signs of cracking or bulging of walls? Yes No Yes No Yes No Yes No Freehold Common hold Leasehold Ownership interest

Remaining term of lease (if leasehold)



Yes No

Name Contact details if consultant monitored



Yes No

Off road parking

Yes No No. of acres

A garden

Yes No

Road charge liability

Yes No

Is there any other secured lending on the property?

Remortgage only Remortgage & home improvements

How many cars will it garage?

Remortgage & debt consolidation Other Remortgage home improvements & debt consolidation

Will the property have:

A conservatory Yes No

Is there a garage? Yes No

Central heating type Gas Electricity Oil Solid fuel Other

Central heating Full Part None


Please provide the following details about the property

Number of bedrooms Number of bathrooms Number of separate toilets Number of living rooms Number of habitable rooms

Reason for remortgage

Other secured lending

Account number Name of lender

To be repaid or postponed

Loan 1

Loan 2

Loan 3

Repaid Postponed Repaid Postponed Repaid Postponed

Yes No Yes No Yes No

Customer advised if deed of postponement or ranking agreement needed

Forename(s) Surname Forename(s) Surname

Other occupants

Please give the names of anybody aged seventeen or over and not party to the mortgage who will live at the property.

Access to the property/land The keys can be obtained from:

Selling agent (if different) Telephone number Evening telephone number Name

Valuation details

Please be aware that we do not allow debt consolidation on remortgage applications from Birmingham Midshires or allow any form of other secured lending on the property whilst still under construction. Where either are identified the application can be declined.


Other contact details

Selling agent’s telephone number Extension

Does your client want the valuation instructing on receipt of the stage 2 form? Has the plot of land already been purchased by your client with their own funds?

If the build has already started it must not be further than the footings/foundation level. Please note that we will not instruct the valuation until the valuation fee has been paid. When your client is ready to pay the valuation fee you will need to contact our processing team who can take payment over the phone via debit/credit card.

Yes No

Yes No

Conveyancers details

Product and fee information

Who is acting for you? Name of firm Address Telephone number Fax number Postcode Yes No

Are you using your own conveyancer?

Provide sub account details

If you have more than three sub account details, refer to section 2 on page 8

Insurance requirements

Has your client arranged Buildings Site Insurance to be in place during the build phase?

The property must be insured. We will contact you with details of our general insurance products and provide no obligation quotes, unless insurance has already been arranged.

Buildings Site Insurance is mandatory as part of this application. Where Buildings Site Insurance is not in place at the start of the build the application will be declined.

Yes No Company Reason for No Yes No Yes No Yes No £ £ £ £ £ £


Supporting information

If you want to provide any additional information to support your application, please use the section below.

Section 1 Additional information on project costings Yes No Yes No Yes No Yes No Yes No Yes No £ £ £ £ £ £ £ £ £ £ £ £

Product Code Product type Amount Years MonthsTerm Repayment type Product fee Product fee to be paid upfront

Section 2 Additional information on sub accounts

Section 3 Any other information you feel we might need to know to help us assess your application for a mortgage, in particular, if the loan extends beyond retirement age. Please confirm how you intend to maintain payments.


Easy ways to make your payments

For your convenience monthly payments will be made from a bank/building society using direct debit. Please complete the section below. Payment mandate

Instructions to your bank or building society to pay direct debits

To: The Manager

Bank or Building Society Address


Please pay Halifax Direct Debits from the account detailed on this Instruction subject to the safeguards assured by The Direct Debit Guarantee.

I understand that this instruction may remain with Halifax and, if so, details will be passed electronically to my Bank/Building Society.

Name of account holder(s) Bank or Building Society account number Branch sort code

Halifax plc reference number

Signature(s) Date

Banks and Building Societies may not accept Direct Debit Instructions for some types of accounts.


The Direct Debit Guarantee – this should be retained

• This Guarantee is offered by all Banks and Building Societies that take part in the Direct Debit Scheme.

The efficiency and security of the scheme is monitored and protected by your own Bank or Building Society.

• If the amounts to be paid or the payment dates change, the Halifax will notify you 4 working days in advance of your

account being debited or as otherwise agreed.

• If an error is made by Halifax, a division of Bank of Scotland plc, or your Bank or Building Society, you are guaranteed

a full and immediate refund from your branch of the amount paid.

Originator’s Identification Number 8 8 3 0 0 8



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