Client Name/s
Adviser Name
Date Completed
Title
Forename (s)
Surname
Previous Surname
Gender
Date of Birth
Marital Status
Do you smoke?
Are you in good health?
Do you have any dependants?
If yes
Dependant Name
Dependant DOB
Full home address (incl. postal code)
Date moved to address
Previous Address (last 3 years)
Residential Status
Home Number
Mobile Number
Work Number
Email Address
Additional Info
Are you employed by a company? (If you are self employed answer question below)
Are you Self Employed?
Occupation
Nature of Occupation
NI Number
Anticipated Retirement Age
Employment Status
Probation Period?
Probation Period Details
Name of Employer
Address of Employer
Period with Employer
Previous Employment Details (last 3 years)
Gross Basic Salary Per annum
Bonus
Is the bonus guaranteed?
Commission
Is the commission guaranteed?
Overtime
Other
Total
Name of Business
Status/Position
Business Start Date
Last 3 years net profit (for Ltd Co, directors salary plus dividend income)
Year 1
Year 2
Year 3
Other Income
Details of other income
Accountant Name
Accountant Address
Accountant Contact Number
Total Gross income from all sources (p/a)
Total Net Monthly Income (A)
Expenditure
Mortgage / Rent
Credit Commitments
Maintenance
Insurances
Utilities
Discretionary Expenditure
Total Monthly Expenditure (B)
Monthly Disposable Income (A - B)
Remaining Income
Any changes to income/expenditure in next 5 years?
Any adverse credit history?
Do you have any current commitments?
Account Details 1
Owner
Type of Loan
Lender
Amount Outstanding
Monthly Payment
Secured?
To be repaid?
Account Details 2
Do you have a current residential mortgage?
Account Number
Current Value
Ownership
Original Mortgage
Term
Repayment Method
Repayment Vehicle
Current Rate Info
Percentage
Until
ERP Info
Amount
Portable?
Do you have any other mortgages?
Address of Property
Rental Income
Type of Application
Address of Property to be Mortgaged
Purchase Price/Value
Deposit Available?
Deposit Amount
Source of Deposit
Mortgage Required
Repayment
Int Only Amount
Capital Rising?
If yes, Reason
Details of affordability into retirement if applicable
Type of Property
Tenure
Leasehold Term (if applicable)
Ex-local?
Year Built
Construction
For Flats / Maisonettes
Purpose Built
Conversion
No. of Floors
Any Commercial
Service Charge
Ground Rent
Type of Rate
Term of Deal Period
Add Fees?
Free Valuation?
Free Solicitors?
Offset?
Speed of Completion
No Booking/Arrangement Fee?
Flexible?
Lowest Monthly Payment?
Lowest APR?
Lowest Cost Over Term?
Capped / upper limit?
Access to cash back?
No ERP?
If interest only, how will you repay the mortgage?
Selling Agents
Solicitors
Bank Details for Mortgage Repayments
Bank
Name
Sort Code
Length Account Held
Do you have any savings currently?
Total Amount readily accessible savings (after deposit) for emergency fund
If no fund, what would you do if your income stopped/reduced?
Do you have any protection arrangements (i.e. life policies)
Type of Policy
Provider
Sum Assured
Monthly Premium
End Date
In trust?
Do you have any employment benefits?
Sickness Benefit
Sickness Benefit Payable For
Death in Service
Death in Service payable for
Have you made a will?
Do you have any investments or pensions?
Property to be Insured
Additional benefits i.e. specified items/legal cover/accidental
Rebuild value
Value of contents
Specified Items (include name & amount)
Include
Excess
Smoke alarm
Free from subsidence/flooding
Alarm
Locks fitted on all windows & doors?
Is there any other information that you feel we should be aware of?