Applicant Name:

1st Applicant 2nd Applicant

Section 2 - Applicant(s) Details

APPLICATION SUMMARYDATA CAPTURE ONLY

Broker First Name

Broker Surname

FCA Number

Telephone Number

Level of Advice

Packaged Application

Packager Name

Packager Telephone Number

Submitted via Mortgage Club

Mortgage Club Name

Mortgage Club Telephone Number

Title:

Forename:

Middle Name:

Surname:

Gender:

Date of Birth:

Retirement Age:

Right to reside in UK

Nationality:

Section 1 - Intermediary Details

Length of Residency in UK:

Martial Status:

UK Citizen:

Page 1 of 6ACC 1543 15/12/14

First Time Landlord:

National Insurance No:

Preferred Contact Method:

Home Telephone No:

Work Telephone No:

Mobile Telephone No:

Email Address:

Title:

Forename:

Middle Name:

Surname:

Previous Names

Page 2 of 6

1st Applicant 2nd Applicant

Section 2 - Applicant(s) Details Continued

Sort Code:

Account Number:

Bank Name:

Bank Address:

Current Bank Account

Account Holder Name:

Length of Time With Bank:

Address:Current Address

Residential Status:

Time at Address:

Postcode Postcode

Years Months Years Months

Postcode Postcode

Years Months Years Months

Address:

Previous Address

Residential Status:

Time at Address:

Address:

Landlord Details for Current Address

Name of Landlord:

Date Tenancy Commenced:

Amount of Rent being paid:

Postcode Postcode

Months Years MonthsYears

Postcode

Section 3 - Employment Details

1st Applicant 2nd Applicant

Employment Status:

Full / Part Time:

Occupation:

Job Title / Position:

Date Start Employment:

Date End Employment:

Share Percentage:

Is Director?:

Basic Salary:

Company Name:

Payroll Number:

Payment Frequency:

Telephone No:

Department:

Page 3 of 6

Section 3 - Employment Details Continued

Address:

1st Applicant 2nd Applicant

Income Details

Area Allowance:

Car Allowance:

Shift Allowance:

Regular Overtime:

Regular Bonus:

Regular Commission:

Mortgage/Housing Allowance:

HR Contact Name:

Telephone No:

Address:

HR Details

Self Employed

Full / Part Time:

Occupation:

Job Title:

Nature of Business:

Business Telephone No:

Start Date:

End Date:

Length Self employed:

Business Name:

Postcode Postcode

Postcode Postcode

VAT No:

Tax Offi ce Name:

Tax Reference:

Employment Address:

Percentage shareholding:

Net Profi t Share:

Business Name:

Postcode Postcode

%%

Year Year

Postcode Postcode

Accountant Details

Name:

Telephone No:

Qualifi cation:

How Long has the accountant acted for the applicant(s)?

Accountant Address:

Other Income Details

Area Allowance:

Car Allowance:

Shift Allowance:

Regular Overtime:

Regular Bonus:

Regular Commission:

Mortgage/Housing Allowance:

Page 4 of 6

Section 3 - Employment Details Continued

Income Type:

Gross Annual Amount:

Start Date:

End Date:

Retirement Income Details

Employment Type:

Job Title:

Employed Date (from):

Employed Date (to):

Previous Employment

1st Applicant 2nd Applicant

Type:

Mortgage Provider:

Account No:

Purchase Date:

Date Mortgaged Commenced:

Balance Outstanding:

Section 4 - Current Mortgage & BTL Commitments

Current Monthly Payment:

Note: All current BTL’s including those which are unencumbered will need to be input when submitting Online.

Shared with Joint Applicant:

Address:

Gross Rent Received:

Rental voids in the last 12 months:Loan to be repaid on completion of mortgage?What was the purpose of the above Mortgage?

Type:

Provider:

Account No:

Balance Outstanding:

Shared with Joint Applicant:

Section 5 - Financial Commitments

Time left to run (in months):

Note: All Commitments must be declared when submitting the application Online.

£ £

£ £

£ £

£ £

£ £

£ £

Postcode Postcode

£ £

£ £

Months Months

Monthly Payment

Page 5 of 6

1st Applicant 2nd Applicant

Has the Applicant ever been behind with any fi nancial commitments:

Commitment Type:

Total No of missed payments in last 24 months:

Section 6 - Applicant Adverse Details

YES NO

Has the Applicant ever had a default registered against them?:

Date Default Registered:

Default Amount:

Defaults

Arrears

Has the Applicant ever had a County Court Judgement against them?:

Date CCJ Registered:

CCJ Amount:

County Court Judgments

Has the Applicant ever been subject to an individual voluntary arrangement?:

Date of IVA:

Date IVA Satisfi ed:

Individual Voluntary Arrangements

YES NO

YES NO YES NO

£ £

YES NO YES NO

£ £

YES NO YES NO

Has the Applicant ever been made bankrupt?:

Date of Bankrupt Order:

Date of Bankruptcy Discharged:

Bankruptcies

Has the Applicant ever been made repossessed?:

Date of Repossession:

Repossession

YES NO YES NO

YES NO YES NO

Section 7 - Loan Details

Loan Purpose:

Type of Loan:

Estimated Value / Purchase Price:

Advance Request:

Term:

Repayment Type:

Source of Deposit

Amount of Deposit

Purpose of Funds

Amount of Funds:

Cashback / Incentives Amount

Section 8 - Security Details

Property Details

Property Address:

Property Description:

Property Type:

Number of Bedrooms:

Number of Bathrooms:

Number of Reception Rooms:

Page 6 of 6

Section 8 - Security Details Continued

Monthly Rental Income

Year Property Built:

Remaining Lease:

Number of fl oors in block:

Floor upon which fl at is located:

Ex-Local authority:

Ex-Ministry of Defence:

Tenure:

Above Commercial Property:

Will agent manage Property:

Purchase Type:

Is Property currently Let?:

How many people reside there?:

Will the tenants remain?:

Name of Tenants?:

Term of Tenancy (months)?:

Name:

Telephone Number:

Is applicant related to the vendor:Does the applicant(s) have a business relationship

with the vendor?:

Address:

Vendor Details

Valuation Type:

Name:

Telephone Number:

Additional Information which will help the valuer to gain access:

Contact Type:

Valuation Type

Arrangement to Access the Property Details

Section 9 - Solicitor Details

Appointed Solicitor

Solicitor Contact Name:

Telephone Number:

Fax Number:

Email Address:

DX Number:

Solicitor Address:

Firm Name:

Section 10 - Direct Debit Details

Is the Account in the name of at least one of the applicants?

Sort Code:

Bank Name:

Bank Address:

Account Holder Name:

Preferred Payment Date:

Account Number:

Accord Mortgages Limited is authorised and regulated by the Financial Conduct Authority. Accord Mortgages Limited is entered in the Financial Services Register under registration

number 305936. Buy to Let Mortgages are not regulated by the Financial Conduct Authority. Accord Mortgages Limited is registered in England No: 2139881. Registered Offi ce:

Yorkshire House, Yorkshire Drive, Bradford BD5 8LJ. Accord Mortgages is a registered Trade Mark of Accord Mortgages Limited.