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PERSONAL LOAN REQUEST FORM
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PERSONAL DETAILS

Full Name:

Date of Birth:

Marital Status:

Number of Dependants:

Nationality:

Email Address:

ADDRESS DETAILS

Current Address:

Postcode:

Home Telephone Number:

Mobile Phone Number (optional):

Time at Current Address*:

*If less than 3 years at current address

Previous Address:

Postcode:

Time at Previous Address:

CURRENT RESIDENTIAL SITUATION

Residential Status:

Home Owner*  

Tenant*  

*If Owner

Property Value:

Outstanding Mortgage:

Monthly Mortgage:

Monthly Council Tax:

*If Tenant

Monthly Rent:

EMPLOYMENT DETAILS

Current Employer / Firm:

Address of Employer / Firm:

Postcode:

Time with Employer / Firm*:

Work Telephone Number:

Annual Income:

Monthly Take Home Pay:

*If Less Than 3 Years with Current Employer

Name of Previous Employer:

BANK DETAILS

Bank Name:

Bank Account Number:

Bank Sort Code:

Time with Bank:

Do you have a Cheque Guarantee Card?

Yes  

No  

How many of the these cards do you have?

Store Cards

Visa

American Express

Mastercard

LOAN REQUIREMENT

Amount of Loan:

Repayment Period:

Purpose of Loan:

Note: If the loan is for consolidation purposes, then please list:
a) Loans to be consolidated
b) The Lenders
c) Approximate Amounts Outstanding
d) Monthly Payments

By submitting this application you confirm that all information given is true and not misleading and that you will notify us immediately of any changes

Confirm that you understand that by the submission of this application your loan is not approved and that you authorise us to make all enquires we feel necessary for deciding whether to proceed with this application.

By submitting this form you agree that we may give the information set out in it to other companies that provide such products and services as indicated. Unless you tell us otherwise by un-ticking the box below the information may also be used to provide you with details of other products and services from time to time.  I AGREE  

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