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Credit history
Have applicant(s) ever been declined a
mortgage?
Have applicant(s) had mortgage or rent
arrears in the last three years?
Have applicant(s) had unsecured arrears in
the last two years?
Have applicant(s) defaulted on loans or had
CCJs in the last three years?
Have applicant(s) been repossessed, made
bankrupt, or taken an IVA in the last six years?
If yes to any of these questions, provide
details giving date, amount and whether
satisfied or not.
First applicant Second applicant
Employment details
Employment status
Shareholding %
Gross annual basic income (for
self employed, profits year 1 - latest year)
Other guaranteed gross annual
income (for self employed, profits year 2)
Other non-guaranteed gross
annual income
(for self employed, profits year 3)
Other gross annual income
(e.g. rental income, investment income or
secondary job, maintenance)
Rate the applicant pays tax at
Time in employment
Occupation
Employer details
(or company details for self employed)
Company name
Nature of business
Number of years trading
(self employed only)
Address
Postcode
Employer telephone number
Contact for references
First applicant Second applicant
No Yes No Yes
No Yes No Yes
No Yes No Yes
No Yes No Yes
No Yes No Yes
