Page 1 of 17
Name of adviser
Company name
FCA reference
number
£
Office address
Email address
Contact telephone
number
Date of advice
Mortgage club
and/or network
Broker fee
(if applicable)
I confirm that the person who has arranged, advised and/or introduced this mortgage is authorised and qualified
to do so. I confirm all documents provided are genuine copies of original documents that have been seen by me.
(*Delete as appropriate)
New business DIP Reference
ReferenceAdditional Borrowing
50+ Mortgage RIO Mortgage
With Fee Without Fee
70% Max LTV
Your firm If relevant, your principle/network
(only available for RIO Mortgage)
(only available for RIO Mortgage)
75% Max LTV
2yr discount 10yr fixed
2yr fixed Fixed for life
5yr fixed
Signed Print name
Please complete this form as accurately as possible as missing information may affect our decision.
Residential Mortgage Application
Adviser Declaration
This application is for
Product
Fee
Interest rate
Date
D M YD M Y
D M YD M Y
LTV option
Retirement Mortgage
(only available for additional borrowing)
Page 1 of 16
50% Max LTV 60% Max LTV
(only available for 5 year fixed rates)
click to sign
signature
click to edit
Page 2 of 17
Self-employment Details
Employment Details
Personal Information
Applicant 1 Applicant 2
Employer name
Employer address
Nature of business
Please complete this section if the Decision in Principle application included income from employment.
Applicant 1 Applicant 2
Business name
Business trading address
Nature of business
Please complete this section if the Decision in Principle application included income from self-employment.
Name of acting accountant
and qualification (e.g. ACA)
Accountant’s telephone number
Accountant’s email address
Accountant’s address
Applicant 1 Applicant 2
Title
Surname
Mr Mrs Miss Ms
Other
Mr Mrs Miss Ms
Other
Full forename(s)
Page 2 of 16
Page 3 of 17
Pensions Income
Pension Savings
Applicant 1
Annual pension income
Spouse benefit
Please tell us more information about any pensions that are already in payment.
Pension Provider
Policy number
£
£
£
£
% %
£
£
Index linked
Y N Y N Y N Y N
% %
Applicant 2
Annual pension income
Spouse benefit
Pension Provider
Policy number
% %
Index linked
Y N Y N Y N Y N
% %
Applicant 1
Age applicant intends
on taking an income
Type of investment
and/or pension
i.e. defined benefit, defined
contribution, drawdown plan, SIPP
Pension/fund provider and
policy number
Please tell us more information about your pension savings that are not yet in payment.
£
£
Fund 1 Fund 2 Fund 3 Fund 4
Fund 1 Fund 2 Fund 3 Fund 4
Fund 1 Fund 2 Fund 3 Fund 4
Page 3 of 16
Page 4 of 17
Accrued pension
at retirement
Spouse Pension
£
£
£
£
%
%
%
%
%
%
%
%
£
£
Index linked
Y N Y N Y N Y N
%
%
%
%
%
%
%
%
For defined benefit savings
Current fund value
£
£
£
£
£
£
For other pension savings
Annual contributions
(employer & employee)
£
£
£
£
% being taken as a lump sum
(if applicable)
Applicant 2
Age applicant intends
on taking an income
Type of investment
and/or pension
i.e. defined benefit, defined
contribution, drawdown plan, SIPP
Pension/fund provider and
policy number
Accrued pension
at retirement
Spouse Pension
Index linked
Y N Y N Y N Y N
For defined benefit savings
Current fund value
For other pension savings
Annual contributions
(employer & employee)
% being taken as a lump sum
(if applicable)
Fund 1 Fund 2 Fund 3 Fund 4
£ £ ££
£ £ ££
Page 4 of 16
Page 5 of 17
Applicant 1
Age applicant intends
on taking an income
Please tell us more about other savings you hold from which you intend taking income in retirement.
Fund 1
Fund 1
Fund 2
Fund 2
Fund 3
Fund 3
Fund 4
Fund 4
Type of investment
Provider & policy
number
Current fund value
Applicant 2
Age applicant intends
on taking an income
Type of investment
Provider & policy
number
Current fund value
Applicant 1
Please tell us more about other retirement income you expect to generate from property. If any of the declared
properties are not currently let please provide confirmation on how long the property has been vacant and why
in the additional information section. For additional properties, please use the additional information section.
Property address
Mortgage lender
Balance outstanding
Monthly contractual
mortgage payment
£ £
£ £
Rental Income
Other Retirement Investments & Savings
£ £ ££
£ £ ££
Page 5 of 16
Page 6 of 17
About your Property
Monthly rent received
Is the property
currently let?
Y N
Estimated property value
Applicant 2
Property address
Mortgage lender
Balance outstanding
Monthly contractual
mortgage payment
Monthly rent received
Is the property
currently let?
Y N
Estimated property value
Tenure
Your property must be suitable security for the mortgage loan. Please complete this section as accurately as
possible to ensure that any issues that could affect your application are identified early. Once you have submitted
this application, we will instruct a surveyor to visit the property to value it.
Type
Freehold Leasehold Commonhold
Absolute
If leasehold,
remaining term
years
Annual service charge
How is the title held? In one name As beneficial joint tenants As tenants in common
Property type
Select property type House Bungalow Flat/Maisonette
If house or bungalow Detached Semi-detached Terraced/Linked
£
£
£
£
£
£
£
£
£
£
£
£
£
Page 6 of 16
Page 7 of 17
If flat/maisonette
Is there a lift?
Y N
On what
floor is it?
Number of
floors in block
Property information
Number of bedrooms
Age of property
years
Date purchased
Annual service charge
Construction
External walls
Brick Stone Timber frame
Roof
Tile Slate Other
If timber frame, is the outer
wall brick, block or stone?
Y N
If flat roof, approx. %
of total roof area
%
New builds
Is this a newly built property?
Y N
If yes, is the property fully completed and habitable?
Y N
If yes, does it have an NHBC or similar warranty? Y N
If it is a flat, is the whole block fully completed?
(including all other flats and communal areas)
Y N
Other factors
Is the property the applicant’s main residence?
Y N
Is the property located in England, Wales or mainland Scotland?
Y N
Was the property previously owned by the public sector?
(i.e. Council, Housing Association or MoD)
Y N
Is the property situated over, or in close proximity to,
retail or business premises?
Y N
£
Page 7 of 16
Page 8 of 17
Occupiers
Access Arrangements on Property to be Mortgaged
Is the property part of a sheltered housing development?
Y N
Do any age restrictions apply to the property?
Y N
Is the property used for any form of business/commercial activity?
Y N
Is the property listed?
Y N
Grade of
listing
Does the property have more than 10 acres of land?
Y N
Are there any agricultural ties or restrictions on the property?
Y N
Has the property ever been flooded or is it at significant risk of flooding?
Y NY N
Has the property ever been subject to underpinning or major structural repair?
Y N
Is the property held in trust? Y N
Has the property had solar panels fitted?
Y N
If yes, are they owned outright or subject to a lease?
Owned
outright
Subject to
a lease
Please give the details of any other occupiers who will reside at the property along with the applicants
(including children) on completion.
Surname First name(s) Occupation/Status Date of birth
Who should the valuer contact to
gain access to the property?
Contact telephone number
If this is a purchase application
please provide contact details,
name and address of the
estate agent
Page 8 of 16
Page 9 of 17
Your Mortgage Repayment Strategy
Downsizing
This section applies to the 50+ Mortgage only. You must have in place a suitable strategy for repaying
the loan at the end of the term. You can use more than one repayment strategy.
What is your current
plan at the end of the
mortgage term?
Purchase a smaller property Purchase a retirement property
Move into sheltered or
rented accommodation
Move in with family
Don’t yet know
Other
(please specify)
How far from your
current home do you
envisage moving?
Stay within the same town/locality
Move to a
different region
(please specify)
Don’t yet know
What is your budget
for purchasing a
new property?
£
No budget required Don’t yet know
Sale of another property owned by the applicant(s) in the UK (e.g Buy to Lets, holiday homes)
Property address
Original date of purchase
D D M M Y Y
Purchase price
£
Name of registered owners
Current mortgage balance
(if applicable)
£
Annual maintenance costs
£
Nil as covered by
rental income
Property type House Bungalow Flat/Maisonette
If leasehold,
remaining term
years
Number of rooms Living rooms Bedrooms Bathrooms
Page 9 of 16
Page 10 of 17
Investments
Provider
Current fund value
Policy/Reference number
Expected maturity date
D D M M Y Y D D M M Y Y
£ £
Monthly contribution
£ £
Y N Y N
Included in outgoings?
Fund 1 Fund 2
Provider
Current fund value
Policy/Reference number
Expected maturity date
D D M M Y Y D D M M Y Y
£ £
Monthly contribution
£ £
Y N Y N
Included in outgoings?
Fund 3 Fund 4
Endowments
Provider
Current fund value
Policy/Reference number
Expected maturity date
D D M M Y Y
£ £
Monthly contribution
£ £
Y N Y N
Included in outgoings?
Fund 1 Fund 2
D D M M Y Y
Page 10 of 16
Page 11 of 17
Provider
Current fund value
Policy/Reference number
Expected maturity date
D D M M Y Y D D M M Y Y
£ £
Monthly contribution
£ £
Y N Y N
Included in outgoings?
Fund 3 Fund 4
Page 11 of 16
Page 12 of 17
Hodge
One Central Square
Cardiff
CF10 1FS
Please fill in this form and send it to us on online or to:
Instructions to your bank
or building society to pay
by direct debit
Names(s) of account holder(s)
Bank/building society account number
Branch sort code
Name and full postal address of your bank or
building society
Address
Postcode
Service user number
Reference
Instructions to your bank or
building society
Please pay Hodge Direct Debits from the account
detailed in this Instruction subject to the safeguards
assured by the Direct Debit Guarantee. I understand
that this instruction may remain with Hodge and,
if so, details will be passed electronically to my
bank/building society.
Signature(s)
Date
The Direct Debit Guarantee
This Guarantee is offered by all banks and building societies that accept instructions to pay Direct Debits
If there are any changes to the amount, date or frequency of your Direct Debit Hodge will notify you 10
working days in advance of your account being debited or as otherwise agreed. If you request Hodge to
collect a payment, confirmation of the amount and date will be given to you at the time of the request
If an error is made in the payment of your Direct Debit, by Hodge or your bank or building society you are
entitled to a full and immediate refund of the amount paid from your bank or building society
If you receive a refund you are not entitled to, you must pay it back when Hodge asks you too
You can cancel a Direct Debit at any time simply by contacting your bank or building society.
Written confirmation may be required. Please also notify us.
To: The Manager Bank/building society
8 4 0 4 4 7
Page 12 of 16
Page 13 of 17
Your Solicitor
Additional Information (Should you require more space, please continue on separate sheets of paper)
You may appoint a solicitor to act for you in taking out a 50+ Mortgage if you wish. They will assist you in understanding
the nature of the long term commitment you are taking on.
Company name
Name of solicitor
acting for you
Address
Telephone
Email
DX
50+ Mortgage only If you are re-mortgaging or raising capital, please confirm if you wish
for Hodge’s solicitors to undertake the legal work in respect of this
mortgage.
Page 13 of 16
Page 14 of 17
Applicant 2
By Phone
By Mail
By Email
By SMS
Declaration
I understand, confirm and agree the following:
Use of your Personal Data
The personal details you give on this form will be
subject to the provisions of the General Data
Protection Regulations 2018.
The information will be retained only for as long as
necessary in accordance with our Retention Policy
by Hodge who is the data controller, and may be
stored on paper or an electronic format.
The information held about you may be used for the
following purposes:
Administering your application
Verifying your identity and anti-money
laundering checks
Assist in fraud prevention
Reporting to regulators and authorities
Market and product analysis.
The information held about you may be shared with
the following parties:
Hodge’s approved service providers in relation
to this application; Other members of Hodge’s
group, its subsidiaries and associated companies
Regulators or authorities where required or
permitted by law.
You have the right to request access to your personal
information held by Hodge; to do so, this request must
be made in writing using our Subject Access Request
Process. Further information regarding this can be
found on our website.
Telephone calls may be monitored and/or recorded in
the interest of security and to help improve our service.
Hodge may also use your information to contact you
about its products and services that it believes may be
of interest to you.
Occasionally, we may have products and services that
could be suitable for you. We would like your permission
to contact you by phone, post, SMS or email.
Please confirm if you would like to hear from us about
these services:
We will always treat your personal details with the
utmost care and will never pass or sell your information
to other companies for marketing purposes.
Your rights as a data subject
At any point while we are in possession of or processing
your personal data, you have the following rights:
Right of access – you have the right to request
a copy of the information that we hold about you
as mentioned above
Right of rectification – you have a right to correct
data that we hold about you that is inaccurate or
incomplete
Right to be forgotten – in certain circumstances you
can ask for the data we hold about you to be erased
from our records
Right to restriction of processingwhere certain
conditions apply you have a right to restrict the
processing
Right of portability – in certain circumstances,
you have the right to have the data we hold about
you transferred to another organisation
Right to object – you have the right to object to
certain types of processing such as direct marketing
Right to object to automated processing, including
profiling – protection against targeted marketing
and decision making
Right to judicial review – in the event that We refuse
your request under rights of access, we will provide
you with a reason as to why. You have the right to
complain as per the subject access request process
All of the above requests will be forwarded on should
there be a third party involved in the processing of
your personal data, i.e. if a data subject was to raise
a Subject Access Request.
Applicant 1
By Phone
By Mail
By Email
By SMS
Page 14 of 16
Page 15 of 17
Declaration
Credit searches and fraud prevention
Hodge will search credit reference and fraud
prevention agencies to check your identity,
credit status and help us to make decisions.
Hodge will undertake a credit search against
each applicant recorded on this form
Information on applications will be sent to credit
reference agencies and will be recorded by them
The credit reference agency will check the
details supplied against third party databases,
public or otherwise
A record of the search will be retained
The credit reference agency may use the details
provided to assist other companies for verification
and identification purposes
If we decline this application, we are not obliged
to tell you the reasons behind our decision
If you borrow from us, we will give details of your
accounts and how you manage it/them to credit
reference agencies. If you borrow and do not
repay in full and on time, credit reference agencies
will record the outstanding debt. This information
may be supplied to other organisations by credit
reference agencies and fraud prevention agencies
to perform similar checks and to trace your
whereabouts and recover debts that you owe.
Records remain on file for six years after they
are closed, whether settled by you or defaulted
If false or inaccurate information is provided and
fraud is identified, details will be passed to fraud
prevention agencies to prevent fraud and
money laundering
Full details of what we do and how we, credit
reference and fraud prevention agencies will use
your information are published on our website.
Alternatively, a copy can be sent to you on
request. Please phone us on 0800 731 4076.
Customer Declaration
I agree to the Terms and Conditions of the account
I have read and understood the Use of Your Personal
Data declaration and consent to the use of my
information for the purposes stated
I declare that the information that I have provided
is correct to the best of my knowledge and belief
I confirm that I wish to proceed on the terms set out
in the Decision in Principle
Where relevant, I enclose payment in order for a
chartered surveyor to value my property. This is
not a survey
I understand that this fee is not refundable, even if the
property is not eligible for this mortgage. Payment of
this fee does not mean that Hodge is obliged to accept
my application
I understand that this mortgage will be subject to
the 50+ Mortgage Terms and Conditions (These will
be provided to you with any offer we issue but in the
meantime, they can also be downloaded from our
website and are available on request)
I have the right to withdraw from this mortgage
application at any time before it is complete and
I have received the monies. However, if I withdraw, I will
not receive a refund of any fees I have paid to Hodge
and I may still be required to pay my financial adviser
and solicitor for the work they have undertaken on my
behalf
All the details in my Decision in Principle and this
application are, to the best of my knowledge and
belief, true and complete. If Hodge finds any to be
untrue, it could affect my eligibility for the mortgage
or reduce the amount I may borrow.
Signed
Print name
D DD DM MM MY YY Y
Date
Signed
Print name
Date
Applicant 1 Applicant 2
Page 15 of 16
Page 16 of 17
mortgages@hodge.co.uk
0800 721 4076
Customers: hodgebank.co.uk
Advisers: hodgebank.co.uk/intermediaries
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.