Secured Application Form Secured Loan Application Personal Details:   Applicant 1 Applicant 2 Title: -- Mr Mrs Miss Ms. Dr Rev Other Title: -- Mr Mrs Miss Ms. Dr Rev Other First name(s): First name(s): Last name: Last name: Date of Birth: Date of Birth: Status: Status married single divorced widowed seperated Status: Status married single divorced widowed seperated Insurance Protection Insurance Protection: single cover double cover none Insurance Protection Insurance Protection: single cover double cover none Occupation: Occupation: Employment Status: -None- Employed Self-Employed Home Maker Employment Status: -None- Employed Self-Employed Home Maker         Daytime Telephone:     Evening Telephone:                 Mobile No.: Email Address: House No./Name: Street Name: Town: County: Postcode:     Other Details:      Where did you find us? Internet Search Newspaper Friend Other       Your Financial Details:  Loan Amount (£):     Purpose of Loan: -None- Debt Consolidation Home Improvement Other     Repayment Period (Months)     Home Value (£):     Current mortgage lender:     Arrears:     Total household income:     Mortgage Balance: Approx.     How would you like to be contacted: -None- Email Post Home Phone Mobile     Data Protection Notice I am the homeowner and by submitting this application I agree that: The information provided is true and accurate, and that you, as a broker, may provide details of this application, to other brokers or lending companies, you feel best suited to fulfil my/our requirements, and that broker/lender may contact me/us for further information as required. A lender may use the information held by credit reference agencies in support of our application, and may ask a third party to verify any information given in the application. You may hold the information given in this application on computer for as long as it takes to complete the loan. By clicking submit you confirm that you have read and accept the Data Protection notice above. Remember there is no obligation, you can pull out at anytime for any reason without penalty.