Your Personal Details
	1st Applicant	2nd Applicant
First Name
Middle Name(s)
Last Name
Date of Birth (dd/mm/yyyy)	/ /	/ /
Marital Status
Current Address
Postcode
How long have you been at this address?	years months	years months

If less than 3 years, please give previous address.
Postcode
How long were you at this previous address?	years months	years months

Please give your address before this previous address.
Postcode

Number Of Dependents
Contact Phone No (Day)
Contact Phone No (Night)
Mobile No.
Email Address
Best way to contact you?
Best time to contact you?

Employment Status
Occupation
Employer Name
Time at current job	years months	years months
How long in continuous employment?	years months	years months
Are you a smoker?	yes no	yes no


Your Mortgage Requirements
Purchasing situation
Where are you in the buying process?
Type of Mortgage
Type of Mortgage rate
Mortgage Period
Amount to Borrow (£s)
Deposit Amount (£s)
Value of property you wish to purchase
Address of the property to be mortgaged
Postcode
Type of Property
Tenure of Property
Number of Bedrooms
How many years are remaining on the lease?
Is the property built of brick / stone with a slate / tile roof?		yes no
If no, please give details
Is the property to be your primary residence?		yes no
If no, please give details
Selling agent details
Buy to Let / Investment Properties ONLY:
Valuation of Property / Properties
Amount of Deposit (min. 15%)
Estimated Rental Income (per month)


Financial Details
	1st Applicant	2nd Applicant
Gross Basic Annual Salary
Overtime, Bonuses, Commission, etc.
Additional Income (e.g. tax credits, rental income, maintenance)
What is this additional income?)
Savings Balance

Credit Card 1
Lender Name
Balance
Monthly Repayment
Would you like to consolidate this?
Credit Card 2
Lender Name
Balance
Monthly Repayment
Would you like to consolidate this?
Credit Card 3
Lender Name
Balance
Monthly Repayment
Would you like to consolidate this?

Personal Loan 1
Lender Name
Balance
Monthly Repayment
Would you like to consolidate this?
Personal Loan 2
Lender Name
Balance
Monthly Repayment
Would you like to consolidate this?
Personal Loan 3
Lender Name
Balance
Monthly Repayment
Would you like to consolidate this?

Monthly Rent / Mortgage Commitments
Other Monthly Outgoings
Do you have any CCJs or other judgments against you?	yes no	yes no
Have you ever been declared bankrupt?	yes no	yes no
Please list all CCJs, arrears or defaults registered against you. Please list the amount, when registered, when satisfied and the reasons.


Existing Mortgage
	1st Applicant	2nd Applicant
Name of lender
Term remaining
Amount still owed
Do you have any redemption penalties from your current lender? (remortgages / home-movers only). If so please state the amount.
Value of current property


Additional Comments or Information



Declarations
To aid us with your application we may need your authority to credit score your application, this enables Lenders to access your credit file using a credit reference agency. Do you give your authority for us to do this on your behalf?		yes no
I declare that the information supplied is true and correct and that I have read the Standard Terms and Conditions.		I AGREE
I agree that Pacific Financial Services ( North West ) may use my data in accordance with their Data Protection Statement.
I agree that Pacific Financial Services (North West) or any company associated with them may contact me for marketing purposes by e-mail, telephone, post or SMS.

Written quotations available. Mortgage or remortgage secured on property. Insurance may be required.

YOUR HOME MAY BE REPOSESSED IF YOU DO NOT KEEP UP REPAYMENTS ON YOUR MORTGAGE. THINK CAREFULLY BEFORE SECURING OTHER DEBTS AGAINST YOUR HOME.

Your home may be repossessed if you do not keep up repayments on your mortgage. The Financial Services Authority does not regulate certain aspects of Buy to let mortgages.

Pacific Financial Services (North West) 150 Briercliffe Rd Burnley Lancs. BB10 2NZ is authorized and regulated by and regulated by the Financial Services Authority We are entered on the FSA register No 302245 at www.fsa.gov.uk/register. There may be a fee for mortgage advice, the precise amount will depend on your circumstances but we estimate that it will be £195. The guidance and/or advice contained within the website is subject to the UK regulatory regime and is therefore primarily targeted at customers in the UK.

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