Please Note : All Fields Marked With * Are Required. Please Complete These Before Submitting.

Client Personal Details

Purpose of loan:
Reference Number:

Applicant One		Applicant Two
Title:	Please Select  Mr Mrs Miss Ms Dr Rev Prof.	Title:	Please Select  Mr Mrs Miss Ms Dr Rev Prof.
First Name:		First Name:
Middle Name:		Middle Name:
Surname:		Surname:
Previous Name:		Previous Name:
Date of Birth:		Date of Birth:
Income Status:	Please Select  Full Status Self Certified	Income Status:	Please Select  Full Status Self Certified
Date Commenced:		Date Commenced:
Current income p.a:		Current income p.a:
Marital Status:	Please Select  Single Living together Married Divorced Seperated	Marital Status:	Please Select  Single Living together Married Divorced Seperated

Client Contact Details

Current Address:					Home Tel No:
					Work Tel No:
					Mobile Number:
Town / City:
Post Code:					Contact me at:	Please Select Morning Afternoon Evening
Time At Address:		Yrs
Previous address needed if current residence has been occupied for less than 3 years.

Previous Address:					Town / City:
					Post Code:

Loan Details

Residential Status: £	Please Select  Owner Occupied Tenant Occupied
Property Type: £	Please Select  Detached Semi-Detached Flat Bungalow Terraced
Outstanding Loan Amount:
Existing Lender:
Est. Property Value:
Loan Amount (Min £10k):	(Not Including Existing Mortgage)
Loan Term: £		Months

Payment Protection Plan: £		(Un-tick box if you DO NOT require PPP)
Broker Fee Charged (%): £		Amount: £

Clients Credit History

Name of 2nd Mortgage Lender:
Amount owed (£):
Name of previous Mortgage Lender If changed in last 12 months

No. of CCJs registered in last 3 years:
Value of CCJs registered in last 3 years:
No. of Mortgage Arrears in last year:
No. of Defaults registered in last 3 years:
Value of Defaults registered in last 3 years:

Existing Unsecured Loans & Credit Cards

Lender	Balance Outstanding	Monthly payment	Repay from loan
			Yes No
			Yes No
			Yes No
			Yes No
			Yes No

Property & Employment Details

Type of property:	House Bungalow Flat/Maisonette
Construction Type:	Brick Concrete
Shared Ownership:	Yes No
Is property Ex-Council?:	Yes No
Discount given if Right-to-Buy (£):
Date purchased:
Purchase price (£):
Current value (£):

Applicant 1
Occupation:
Employment Status:	Employed Self-Employed
Time in job:	years months
Monthly gross income (£):
Details of other income:
Applicant 2
Occupation:
Employment Status:	Employed Self-Employed
Time in job:	years months
Monthly gross income (£):
Details of other income:

Broker Details

Title:	Please Select  Mr Mrs Miss Ms Dr Rev Prof.	Telephone No:	*
First Name:	*	Fax No:
Surname:	*	Mobile No:
Company Name:	*	E-Mail Address:	*

Declaration

IMPORTANT INFORMATION In submitting this case you confirm that you give authority for Opus to carry out any Credit Checks required and understand and accept that any product information provided is based on the details aforementioned.

Please Note : All Fields Marked With * Are Required. Please Complete These Before Submitting.