• Personal Information
  • Employment and Income
  • Financial Details

Client 1

Title

Full Name

Sex

Date of Birth

Full Address

Have you lived here for more than 3 years?

If no, please provide previous full address

National Insurance number

Phone Number

Email

Resident in the UK?

Good Health?

Do you smoke?

Have you made a will?

Client 2 (if applicaple)

Title

Full Name

Sex

Date of Birth

Marital Status

Full Address

Have you lived here for more than 3 years?

If no, please provide previous full address

National Insurance number

Phone Number

Email

Resident in the UK

Good Health?

Do you smoke?

Have you made a will?

Name & age of dependants

Employment (Client 1)

Employment status

Name, address and telephone of employer

Job title

Time in continuous employement (Years/months)

Basic Annual income (£) (before tax)

Average Monthly Bonus/ Commission/ Overtime payments (£)

Any other monthly income (£)

Please confirm other income sources (Amounts & source)

Total Annual Income (£)

Monthly Income (£) (after tax)

Employment (Client 2)

Employment status

Name, address and telephone of employer

Job title

Time in continuous employement (Years/months)

Basic Annual income (£) (before tax)

Average Monthly Bonus/ Commission/ Overtime payments (£)

Any other income (£)

Please confirm other income sources (Amounts & source)

Total Annual Income (£)

Monthly Income (£) (after tax)

Self employed (please only answer if relevant)

Self employed type

Name and address of company

Nature of Business

Company registration number (if applicable)

Date started self employment?

Name and address of accountants.

What qualifications do your accountants hold?

Please confirm your last 3 years net profit figures.

Total Annual income (£)

Monthly Expenditure (per month)

Mortgage / Rent (£)

Electricity/ Gas / Water (£)

Phone / Internet / Mobile / TV (£)

Council Tax (£)

Household insurance (£)

Other insurance (£)

Loan/ Hire purchase (£)

Child Care (£)

School Fees (£)

Motoring Costs (£)

Public Transport (£)

Life assurance (£)

Regular savings/ Pensions (£)

Food & Clothing (£)

Cigarettes/ Alcohol (£)

Hobbies / Socialising (£)

Other (£)

All current mortgages (if applicable)

Which client has this mortgage?

Name of Lender

Account number

Date Mortgage started

Approximate outstanding balance (£)

Monthly payments (£)

What type of mortgage is it?

If you have addtional mortgages, please provide more details below.

Other Credit arrangements

Total balance on Credit Cards (£)

Balance on Overdraft (£)

Any other outstanding credit arrangements?

Financial History

Have you ever been made bankrupt?

Have you had any CCJs/ Defaults?

Have you got an Arrears?

Have you ever had a repossesion?

Please give details of any adverse credit history.