Milecross Group - Financial Services in Northern Ireland

Please fill out the form as fully as possible to avoid delays. It is not necessary to fill in every box but obviously the more information we have the faster our response will be. (All areas marked with a * must be filled in)

MORTGAGE DETAILS
	1st Applicant	2nd Applicant
* Surname
* First Names
* Title
* Marital Status
* Date of birth
* Present Address
* At this address yrs mths
Work Telephone No.
* Home Telephone No.
Mobile Telephone No.
* E-mail Address

DETAILS OF PROPERTY
* Estmated Present Value For Remortgage Purposes (£)		Type of purchase
* How much do you wish to borrow? (£)		If changing home, Purchase Price (£)
If ex-council please state the discount received (£)

DETAILS OF YOUR CURRENT MORTGAGE
* Name of current lender (if applicable)		Balance Outstanding (£)
Monthly repayment (£)		Highest No of Months in arrears in last 12 months (if any)
Current Mortgage arrears(£) (if any)		If you have remortgaged within the last twelve months, please give the date
Monthly endowment payment (£) (if applicable)

DETAILS OF EMPLOYMENT
	1st Applicant	2nd Applicant
* Occupation
* Length of this employment
* Gross Annual Income (£)
* Other Income (£)
* Pension Income (£)
* Net Monthly Income (£)
(To be completed if you are self employed)
Net Profit (last two years)	Year Year	Year Year
Are accounts available?	Yes No	Yes No
Are accounts available?	Accountants Qualifications	Accountants Qualifications
WE HAVE SCHEMES FOR SELF EMPLOYED WITHOUT ACCOUNTS
Have you proof of your self employed status
If other please give details

OUTGOINGS OTHER THAN MORTGAGE
Do you have any outgoings other than mortgage?	Yes	No

	Lenders Name	Balance (£)	Monthly Repayments (£)	Arrears (£)	If re-mortgage, are you repaying this?
Secured Loan					Yes No
Other Credit					Yes No
Other Credit					Yes No
Other Credit					Yes No

Credit History	Number of CCJs	Total Amount CCJ's
Information about CCJs (please fill this in if you have any CCJs)
	Date	Amount	Satisfied
CCJ No 1			Yes No
CCJ No 2			Yes No
CCJ No 3			Yes No
Please disclose all arrears, CCJ's etc as long as we are aware of them our schemes can take them into account. If you have ever been bankrupt please give details below:-

HOW DID YOU HEAR ABOUT MILECROSS GROUP
*	If other, please specify

Which method may we contact you:-

Telephone

Post

E-mail

I/We confirm that the information given is true and not misleading. I/We understand that the above information is supplied to Milecross Group with the sole purpose of evaluating which lender and scheme would suit me/us best. Milecross Group undertakes to keep all Information supplied totally confidential and will not be submitted to any 3rd party without your prior consent.

"I/We give consent to Milecross Group to carry out a credit search for
mortgage purposes"