DOMESTIC MORTGAGE APPLICATION FORM Surname Forename (s) Telephone Have you ever been judged bankrupt? Yes No If YES please provide details Have you ever had any defaults? Yes No If YES please provide details Have you ever had any county court judgements? Yes No If YES please provide details Have you ever had any arrears? Yes No If YES please provide details Do you have loans/HP agreements? Yes No If YES please provide details OCCUPATION & INCOME: Status Employed Self Employed Date started Basic gross income per annum £  per year Overtime/Commission/ Bonus £  per year Details of further income £  per year Last 3 trading years net profit £  per year FURTHER INFORMATION Purpose of loan Property Remortgage Loan required £ Terms Years Are you a first time buyer? Yes No Estimated value of property £ Outstanding balance £ Have you ever had any arrears? Yes No If YES please provide details     site maintained by Swiftsite ltd Home Application Form 26 Walnut Park Haywards Heath West Sussex RH16 3TG Tel: 01444 417474 Fax: 01444 410878 finance999@aol.com