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Mortgage type required		Remortgage First Time Buyer Next Time Buyer Buy To Let
Property description		Property Description ? House Bungalow Flat Maisonnette
Property style		Property Style ? Detached Semi detached Terrace End of terrace Converted flat Purpose built flats Purpose built maisonnette
Property purpose		Property Usage ? Primary Residence Secondary/Vacation Investment
Have you found a home?		Yes No
Estimaged value of property	£	Estimated Property Value ? 50,000 - 54,999 55,000 - 59,999 60,000 - 64,999 65,000 - 69,999 70,000 - 74,999 75,000 - 79,999 80,000 - 84,999 85,000 - 90,999 90,000 - 94,999 95,000 - 99,999 100,000 - 104,999 105,000 - 109,999 110,000 - 114,999 115,000 - 119,999 120,000 - 124,999 125,000 - 129,999 130,000 - 134,999 135,000 - 139,999 140,000 - 144,999 145,000 - 149,999 150,000 - 154,999 155,000 - 159,999 160,000 - 164,999 165,000 - 169,999 170,000 - 174,999 175,000 - 179,999 180,000 - 184,999 185,000 - 189,999 190,000 - 194,999 195,000 - 199,999 200,000 - 209,999 210,000 - 219,999 220,000 - 229,999 230,000 - 239,999 240,000 - 249,999 250,000 - 259,999 260,000 - 269,999 270,000 - 279,999 280,000 - 289,999 290,000 - 299,999 300,000 - 309,999 310,000 - 319,999 320,000 - 329,999 330,000 - 339,999 340,000 - 349,999 350,000 - 359,999 360,000 - 369,999 370,000 - 379,999 380,000 - 389,999 390,000 - 399,999 400,000 - 419,999 420,000 - 439,999 440,000 - 459,999 460,000 - 479,999 480,000 - 499,999 500,000 - 519,999 520,000 - 539,999 540,000 - 559,999 560,000 - 579,999 580,000 - 599,999 600,000 - 619,999 620,000 - 639,999 640,000 - 659,999 660,000 - 679,999 680,000 - 699,999 700,000 - 719,999 720,000 - 739,999 740,000 - 759,999 760,000 - 779,999 780,000 - 799,999 800,000 - 819,999 820,000 - 839,999 840,000 - 859,999 860,000 - 879,999 880,000 - 899,999 900,000 - 919,999 920,000 - 939,999 940,000 - 959,999 960,000 - 979,999 980,000 - 999,999 Over 1,000,000
Amount to borrow	£	Amount To Borrow ? 50,000 - 54,999 55,000 - 59,999 60,000 - 64,999 65,000 - 69,999 70,000 - 74,999 75,000 - 79,999 80,000 - 84,999 85,000 - 90,999 90,000 - 94,999 95,000 - 99,999 100,000 - 104,999 105,000 - 109,999 110,000 - 114,999 115,000 - 119,999 120,000 - 124,999 125,000 - 129,999 130,000 - 134,999 135,000 - 139,999 140,000 - 144,999 145,000 - 149,999 150,000 - 154,999 155,000 - 159,999 160,000 - 164,999 165,000 - 169,999 170,000 - 174,999 175,000 - 179,999 180,000 - 184,999 185,000 - 189,999 190,000 - 194,999 195,000 - 199,999 200,000 - 209,999 210,000 - 219,999 220,000 - 229,999 230,000 - 239,999 240,000 - 249,999 250,000 - 259,999 260,000 - 269,999 270,000 - 279,999 280,000 - 289,999 290,000 - 299,999 300,000 - 309,999 310,000 - 319,999 320,000 - 329,999 330,000 - 339,999 340,000 - 349,999 350,000 - 359,999 360,000 - 369,999 370,000 - 379,999 380,000 - 389,999 390,000 - 399,999 400,000 - 419,999 420,000 - 439,999 440,000 - 459,999 460,000 - 479,999 480,000 - 499,999 500,000 - 519,999 520,000 - 539,999 540,000 - 559,999 560,000 - 579,999 580,000 - 599,999 600,000 - 619,999 620,000 - 639,999 640,000 - 659,999 660,000 - 679,999 680,000 - 699,999 700,000 - 719,999 720,000 - 739,999 740,000 - 759,999 760,000 - 779,999 780,000 - 799,999 800,000 - 819,999 820,000 - 839,999 840,000 - 859,999 860,000 - 879,999 880,000 - 899,999 900,000 - 919,999 920,000 - 939,999 940,000 - 959,999 960,000 - 979,999 980,000 - 999,999 Over 1,000,000
Do you need to self-certify your income?		Yes No
Do you have any other debt (eg. Credit Card Debt)?		Yes No
What is your employment status?		Employed Self-Employed Retired Unemployed
Do you have a CCJ?		No Yes
Do you have an IVA?		No Yes
Have you missed a mortgage payment in the past 12 months?		No Yes
Have you declared bankruptcy?		No Not in Past 7 Years Less than a year 1 - 2 Years ago 2 - 5 Years ago 5 -7 Years ago
How soon would you like to apply for a mortgage?		1 - 2 Weeks 3 - 5 Weeks 6 - 12 Weeks
Personal Details
Title		Mr Dr Mrs Ms Miss Other
First name
Surname
Date of birth		Day ? 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month ? 01 02 03 04 05 06 07 08 09 10 11 12 Year ? 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901
Primary phone
Secondary phone
Best time to call		Morning Afternoon Evening
Email
Address 1
Address 2
Town/City
County
Post Code
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