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Portfolio Buy To Let Additional Applicant Form
Name of adviser
Director/Partner/Shareholder Details
This form is to be completed in conjunction with the Portfolio Buy To Let Application Form and the Portfolio Tenancy
Schedule.
This form will capture information on additional Directors/Partners and the ultimate beneficial owners (if not stated as a
Director/Partner) who are defined as individuals with a shareholding/ownership of 25% or more in the company.
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Customer name
Date
Full name including title
Y N
If yes, previous full name
Have you been known by
any other name(s) in the
last 3 years?
Marital status
D M YD M
Date of birth
Telephone
Email
D M YD M
Nationality
Y N
Current resident in the UK
Length of UK residency
Years
Y N
Shareholder
If yes, share percentage
%
Address
Postcode
Residential status
Time at address
Months/Years
Personal Details
Y
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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.
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