To ensure that suitable advice is provided and recommendations are based on your current financial circumstances it is important that questions are answered as fully and accurately as possible.

Email *

Your full name *

Are you Applicant 1 or Applicant 2?

Select option

Relationship to other client

Select option

Dependants: name(s), age, relationship and residence

Smoker

Yes

Are you, or are you connected to, a politically exposed person?

Yes

Current residential status

Select option

If renting, amount of rent paid

Per week or per month?

Select option

Are you on the electoral roll at your current address?

Yes

Length of time at current address – years

Length of time at current address – months

Previous address (if less than 3 years at current address)

Previous postcode

Are you currently in good health?

Yes

If no, please provide details

Employment & Income

Employment status

Select option

If “other”, give details

Current employer

Occupation / Job title

If employed, on what basis?

Select option

Time in current employment – years

Time in current employment – months

Details of probationary period – years

Details of probationary period – months

If contract, specify term of contract – years

If contract, specify term of contract – months

Previous employer if less than 2 years, to include dates of employment

Anticipated retirement age

Basic annual income

Guaranteed overtime

Guaranteed bonuses

Non-guaranteed overtime

Non-guaranteed bonuses

Number of years in business – years

Number of years in business – months

Net profit last year

Net profit previous year

Net profit year before that

Are accounts available?

Yes

Are SA302s available?

Yes

Do you receive any other income?

Yes

Car allowance

Investment income

Rental income

Pension

State benefits (guaranteed)

State benefits (reviewable)

Maintenance payments

Other income – description

Other income – amount

Please fill out the below with regards all existing credit you have currently. This includes credit cards, personal loans, hire purchase agreements, lease contracts or any credit you act as a guarantor on.

Do you have any existing credit commitments?

Yes

Credit 1 – Type of finance

Select option

Credit 1 – Finance provider

Credit 1 – Balance outstanding

Credit 1 – Months outstanding

Credit 1 – Monthly payment

Credit 1 – Purpose of credit / guarantor

Credit 1 – Secured?

Yes

Credit 1 – Repay with mortgage?

Yes

Credit 2 – Type of finance

Select option

Credit 2 – Finance provider

Credit 2 – Balance outstanding

Credit 2 – Months outstanding

Credit 2 – Monthly payment

Credit 2 – Purpose of credit / guarantor

Credit 2 – Secured?

Yes

Credit 2 – Repay with mortgage?

Yes

Credit 3 – Type of finance

Select option

Credit 3 – Finance provider

Credit 3 – Balance outstanding

Credit 3 – Months outstanding

Credit 3 – Monthly payment

Credit 3 – Purpose of credit / guarantor

Credit 3 – Secured?

Yes

Credit 3 – Repay with mortgage?

Yes

Credit 4 – Type of finance

Select option

Credit 4 – Finance provider

Credit 4 – Balance outstanding

Credit 4 – Months outstanding

Credit 4 – Monthly payment

Credit 4 – Purpose of credit / guarantor

Credit 4 – Secured?

Yes

Credit 4 – Repay with mortgage?

Yes

Credit 5 – Type of finance

Select option

Credit 5 – Finance provider

Credit 5 – Balance outstanding

Credit 5 – Months outstanding

Credit 5 – Monthly payment

Credit 5 – Purpose of credit / guarantor

Credit 5 – Secured?

Yes

Credit 5 – Repay with mortgage?

Yes

Credit 6 – Type of finance

Select option

Credit 6 – Finance provider

Credit 6 – Balance outstanding

Credit 6 – Months outstanding

Credit 6 – Monthly payment

Credit 6 – Purpose of credit / guarantor

Credit 6 – Secured?

Yes

Credit 6 – Repay with mortgage?

Yes

Any other credit details

Have you ever had a mortgage or loan application refused?

Yes

Have you ever had a judgement for (a guarantor) debt or loan default registered against you?

Yes

Have you ever been declared bankrupt?

Yes

Have you ever failed to keep up repayments under any previous or current mortgage?

Yes

Have you ever failed to keep up repayments under any previous or current rental or loan agreement?

Yes

If yes to any of the above, provide full details

Buy to let property, second homes and holiday homes

Property

Any other assets

Details

Do you have a will?

Yes

When was it last reviewed?

Do you have a lasting power of attorney?

Yes

Would you like more information on the above?

Yes

Life insurance?

Yes

Critical illness cover?

Yes

Income protection?

Yes

Please detail any protection details

I agree to receive text messages from Akorn Financial Advice about my mortgage enquiry and appointments. Message frequency varies. Reply STOP to opt out.

I'd like to receive occasional updates and offers from Akorn Financial Advice by text. Reply STOP to opt out.

Tell us about you

Employment & Income