Address of property to be used as Security:

Country:

Description of Property:

Purchase Price / Valuation:

Deposit:

Financing Required / Currency:

Term of years required:

If Re-finance, what is the purpose:

Type of Mortgage (Repayment / Endowment / Other):

Additional Cost of Home Improvements:

Is the Property to be Constructed:

If yes, please give completion date & when schedule of funds are required:

Full Name and Address of Builder / Developer:

Tel / Fax Number:

Use of Property (Vacation Home / Retirement / Rental etc):

Other information:

Declaration

These particulars are believed to be complete and correct and may be disclosed to appropriate parties in connection with pre-qualification, financing and purchasing or real estate. If it is incomplete I/We accept that I/We may not receive advice appropriate
to my/our circumstances.

I / We agree that the lender may take up any references it considers necessary for the confirmation of all of these particulars and for Credit Assessment.

UK Based Applicants Only
(as required under the Data Protection Act 1984)

I / We confirm that I / We will have access to our personal records held on any computer files. I / We consent to the processing and storage of personal information on computer and / or paper files. I / We understand that processing may occur outside the European Economic Area.