M o r t g a g e  E n q u i r y  F o r m

This mortgage enquiry form will alllow us to take into account your individual mortgage needs and evolve a scheme specific to your circumstances.

  

Your Details	Applicant 1	Applicant 2
Full Name
D.O.B
Present Address including postcode
Length of time at address
Home Tel Number
Work Tel Number
Preferred time of contact	Home Work	Home Work
Preferred means of contact	E-mail       Telephone        Post
E-mail address
Income & Expenditure	Applicant 1	Applicant 2
Gross Basic Annual Earnings
Gross Annual Overtime
Gross Annual Commission
Will income increase with	Annual Rate of Inflation Promotion Change of Employment	Annual Rate of Inflation Promotion Change of Employment
Loan 1 Monthly Payments	exp date	exp date
Loan 2 Monthly Payments	exp date	exp date
Loan 3 Monthly Payments	exp date	exp date
Credit Card No 1	Monthly Payment           Balance outstanding	Monthly Payment            Balance Outstanding
Credit Card No 2	Monthly Payment           Balance Outstanding	Monthly Payment            Balance Outstanding
Store Card No 1	Monthly Payment           Balance Outstanding	Monthly Payment            Balance Outstanding
Store Card No 2	Monthly Payment           Balance Outstanding	Monthly Payment            Balance Outstanding
Property Details
Purchase Price/Approximate Valuation	Please select one: Homemover Remortgage First Time Buyer
Mortgage Required	Please select one: Repayment Interest Only(ISA/Endow) Part/Part
Term
Existing Lender if moving home or remortgaging	Balance Outstanding              Amount of any penalty
Type of mortgage required	Variable Fixed Rate Capped Rate     Please select one: 1yr 2yr 3yr 4yr 5yr
Will you accept redemption penalties for the period of the reduced rate?	No Yes
Other Details
In order that we can advise you fully are there any circumstances that you can foresee such as job move, lump sum, to pay off the mortgage etc. Please detail:
We are also able to quote competitively for life cover. Do you require this? Yes        No If so, please complete the additional information below:
Smoker?	No              Yes	No              Yes
Type of cover required	Term Mortgage Protection Term with critical illness

YOUR HOME IS AT RISK IF YOU DO NOT KEEP UP
REPAYMENTS ON A MORTGAGE OR ANY OTHER LOAN SECURED ON IT.
Loans are secured on property. Written details on request. Miers Ltd are independent
financial advisers regulated by the Financial Services Authority. Mortgages are not regulated by the PIA.

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