Individual Application Contact First Name Contact Last Name Date Firm Network / Mortgage Club Telephone Mobile Email Broker Fee A. Loan Details What are the funds going to be used for? (explanation required) What is the net amount required? (£) Term of the loan? how will the Loan be repaid? (explanation required) B. Application Details Applicant 1 Title Full Name Address Postcode Telephone Email Date of Birth Marital Status Applicant 2 (or Guarantor) Title Full Name Address Postcode Telephone Email Date of Birth Marital Status C. Property being used as security for the loan Full Address of property Postcode Ownership Ownership Already owned Being Purchased Purchase price/price paid (£) Estimated value of the property (£) Outstanding mortgage(s) on Property, if already owned (£) Name of lender(s) Property Description Are additional additional properties being provided as security? Are additional additional properties being provided as security? Yes No Any other relevant information SUBMIT FORM