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Address
Postcode
Residential status
Time at address
Months/Years
If less than 3 years, please provide previous address
Credit History
Y N
Have you ever been
bankrupt/sequestrated?
Date of discharge
Y N
Have you ever entered into
an IVA or made arrangements
with creditors?
Date of satisfaction
Y N
Any defaults registered in
last 36 months?
Total amount of defaults
registered in the last 36
months
Y N
Any CCJs registered in last
36 months?
Date of most recent CCJ
£
Total amount of CCJs
registered in the last 36
months
£
Number of CCJs
registered in last 36
months
Y N
Have you ever been
convicted of theft, fraud or
dishonesty?
If yes, please state the
date of conviction
Nature of conviction
Length of conviction
(included suspended)
Signed Print name
D D M M Y Y
Date
By signing below, you confirm that you have read and consent to the Hodge terms and conditions outlined in the
Portfolio Buy To Let Application Form.
mortgages@hodge.co.uk
0800 721 4076
Customers: hodgebank.co.uk
Advisers: hodgebank.co.uk/intermediaries
Our Portfolio Buy To Let loan is not regulated by the Financial Conduct Authority.
Hodge is a trading name of Julian Hodge Bank Limited which is authorised by the Prudential Regulation Authority and regulated
by the Financial Conduct Authority and the Prudential Regulation Authority under registration number 204439. Registered office
in England & Wales is One Central Square, Cardiff, CF10 1FS (No.743437). Hodge’s Privacy Notice confirms how we manage and
process your personal data. If you require more detail on how we handle your information please go to hodgebank.co.uk/
privacy or call 0800 289 358.
click to sign
signature
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