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Lead Generated From: Home-Improvement-Loan-UK.com

Residential Status: - Select - Homeowner with Mortgage Homeowner with No Mortgage Student Acc. Tenant Living with Parents

Loan Amount In £: - Select - £5,000 £6,000 £7,000 £8,000 £9,000 £10,000 £11,000 £12,500 £13,000 £14,000 £15,000 £16,000 £17,000 £18,000 £19,000 £20,000 £25,000 £30,000 £35,000 £40,000 £45,000 £50,000 £55,000 £60,000 £65,000 £70,000 £80,000 £90,000 £100,000 £100,000+ -Loan Purpose- ------------ Home Improvement Debt Consolidation Business Finance ------------ Furniture Purchase Electrical Equipment Purchase Holiday Wedding Cosmetic Surgery Medical Expenses School Tuition Fee Christmas

Repayment Period: - Select - 60 months/5 years 72 months/6 years 84 months/7 years 96 months/8 years 108 months/9 years 120 months/10 years 132 months/11 years 144 months/12 years 156 months/13 years 168 months/14 years 180 months/15 years 192 months/16 years 204 months/17 years 216 months/18 years 228 months/19 years 240 months/20 years 252 months/21 years 264 months/22 years 276 months/23 years 288 months/24 years 300 months/25 years

Had a CCJ or Default registered against you? - Select - No Yes

Missed any loan or mortgage payments in the last 12 months? - Select - No Yes

Been declared bankrupt or had an IVA? - Select - No Yes

ABOUT YOU

First Name / Surname: Mr Mrs Miss Ms Rev Doc Hon

Mother's Maiden Name:

Do You Have Permanent Rights To Reside In The UK? Yes No

Date Of Birth: dd 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 mm Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec yyyy 1988 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

Employment Status: - Select - Full Time Part Time Disabled Housewife Househusband Retired Self-Employed Student Unemployed Other

Proof Of Income If Self-Employed: - Select - 2 yrs Cert/Chartered Accts Self Certification Accountants Letter

Occupation:

Time In Present Job: - Years - < 1 year 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years 10 years 11 years 12 years 13 years 14 years 15 years 16 years 17 years 18 years 19 years 20 years 21 years 22 years 23 years 24 years 25 years 26 years 27 years 28 years 29 years 30 years 31 years 32 years 33 years 34 years 35 years 36 years 37 years 38 years 39 years 40 years 41 years 42 years 43 years 44 years 45 years 46 years 47 years 48 years 49 years 50 years - Months - 1 month 2 months 3 months 4 months 5 months 6 months 7 months 8 months 9 months 10 months 11 months 12 months

Annual Income Before Tax: - Select - £1,000 £2,000 £3,000 £4,000 £5,000 £6,000 £7,000 £8,000 £9,000 £10,000 £11,000 £12,000 £13,000 £14,000 £15,000 £16,000 £17,000 £18,000 £19,000 £20,000 £21,000 £22,000 £23,000 £24,000 £25,000 £26,000 £27,000 £28,000 £29,000 £30,000 £31,000 £32,000 £33,000 £34,000 £35,000 £36,000 £37,000 £38,000 £39,000 £40,000 £41,000 £42,000 £43,000 £44,000 £45,000 £46,000 £47,000 £48,000 £49,000 £50,000 £51,000 £52,000 £53,000 £54,000 £55,000 £56,000 £57,000 £58,000 £59,000 £60,000 £61,000 £62,000 £63,000 £64,000 £65,000 £66,000 £67,000 £68,000 £69,000 £70,000 £71,000 £72,000 £73,000 £74,000 £75,000 £76,000 £77,000 £78,000 £79,000 £80,000 £81,000 £82,000 £83,000 £84,000 £85,000 £86,000 £87,000 £88,000 £89,000 £90,000 £91,000 £92,000 £93,000 £94,000 £95,000 £96,000 £97,000 £98,000 £99,000 £100,000

Do You Have Any Additional Income?: Yes No

If Yes, How Much Is This Annually?

Source Of This Income

Years With Your Bank - Select - 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years 10 years or more

Marital Status: Single Married Divorced Widow Widower Separated Living with Partner Other

Maiden Name :

PARTNER INFORMATION

First Name / Surname: Mr Mrs Miss Ms Rev Doc Hon

Do You Have Permanent Rights To Reside In The UK? Yes No

Date Of Birth: dd 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 mm Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec yyyy 1988 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

Home Phone Number:

Mobile Phone Number:

If you do not have a mobile number, please enter your home phone number or second phone number

Maiden Name :

Employment Status: Full Time Part Time Housewife Househusband Disabled Retired Self-Employed Student Unemployed Other

Proof Of Income If Self-Employed: - Select - 2 yrs Cert/Chartered Accts Self Certification Accountants Letter

Time In Present Job: - Years - < 1 year 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years 10 years 11 years 12 years 13 years 14 years 15 years 16 years 17 years 18 years 19 years 20 years 21 years 22 years 23 years 24 years 25 years 26 years 27 years 28 years 29 years 30 years 31 years 32 years 33 years 34 years 35 years 36 years 37 years 38 years 39 years 40 years 41 years 42 years 43 years 44 years 45 years 46 years 47 years 48 years 49 years 50 years - Months - 1 month 2 months 3 months 4 months 5 months 6 months 7 months 8 months 9 months 10 months 11 months 12 months

Annual Income Before Tax: - Select - £0 £1,000 £2,000 £3,000 £4,000 £5,000 £6,000 £7,000 £8,000 £9,000 £10,000 £11,000 £12,000 £13,000 £14,000 £15,000 £16,000 £17,000 £18,000 £19,000 £20,000 £21,000 £22,000 £23,000 £24,000 £25,000 £26,000 £27,000 £28,000 £29,000 £30,000 £31,000 £32,000 £33,000 £34,000 £35,000 £36,000 £37,000 £38,000 £39,000 £40,000 £41,000 £42,000 £43,000 £44,000 £45,000 £46,000 £47,000 £48,000 £49,000 £50,000 £51,000 £52,000 £53,000 £54,000 £55,000 £56,000 £57,000 £58,000 £59,000 £60,000 £61,000 £62,000 £63,000 £64,000 £65,000 £66,000 £67,000 £68,000 £69,000 £70,000 £71,000 £72,000 £73,000 £74,000 £75,000 £76,000 £77,000 £78,000 £79,000 £80,000 £81,000 £82,000 £83,000 £84,000 £85,000 £86,000 £87,000 £88,000 £89,000 £90,000 £91,000 £92,000 £93,000 £94,000 £95,000 £96,000 £97,000 £98,000 £99,000 £100,000

CONTACT DETAILS

House Address: (without commas)

Town/City: (without commas)

Postcode:

Lived In Your Home For: - Select - Less than 3 years 3 Years 4 Years 5 Years 6 Years 7 Years 8 Years 9 Years 10 Years 11 Years 12 Years 13 Years 14 Years 15 Years 16 Years 17 Years 18 Years 19 Years 20 Years

E-mail Address:

Home Phone Number:

Please enter above a valid UK landline number

Mobile Phone Number:

If you do not have a mobile number, please enter your home phone number or second phone number

Best Contact Time: - Select - Morning Afternoon Evening Today 1 days time 2 days time 3 days time 4 days time 5 days time 6 days time

PREVIOUS ADDRESS

Previous House Address: (without commas)

Town/City: (without commas)

Postcode:

YOUR MORTGAGE

Property Value: - Select - £50,000 £60,000 £70,000 £80,000 £90,000 £100,000 £110,000 £120,000 £130,000 £140,000 £150,000 £160,000 £170,000 £180,000 £190,000 £200,000 £210,000 £220,000 £230,000 £240,000 £250,000 £260,000 £270,000 £280,000 £290,000 £300,000 £310,000 £320,000 £330,000 £340,000 £350,000 £360,000 £370,000 £380,000 £390,000 £400,000 £410,000 £420,000 £430,000 £440,000 £450,000 £460,000 £470,000 £480,000 £490,000 £500,000 £510,000 £520,000 £530,000 £540,000 £550,000 £560,000 £570,000 £580,000 £590,000 £600,000 £610,000 £620,000 £630,000 £640,000 £650,000 £660,000 £670,000 £680,000 £690,000 £700,000 £710,000 £720,000 £730,000 £740,000 £750,000 £760,000 £770,000 £780,000 £790,000 £800,000 £810,000 £820,000 £830,000 £840,000 £850,000 £860,000 £870,000 £880,000 £890,000 £900,000 £910,000 £920,000 £930,000 £940,000 £950,000 £960,000 £970,000 £980,000 £990,000 £1,000,000

Mortgage Balance: - Select - None £1,000 £2,000 £3,000 £4,000 £5,000 £6,000 £7,000 £8,000 £9,000 £10,000 £15,000 £20,000 £25,000 £30,000 £35,000 £40,000 £45,000 £50,000 £60,000 £70,000 £80,000 £90,000 £100,000 £110,000 £120,000 £130,000 £140,000 £150,000 £160,000 £170,000 £180,000 £190,000 £200,000 £225,000 £250,000 £275,000 £300,000 £325,000 £350,000 £375,000 £400,000 £425,000 £450,000 £475,000 £500,000 £525,000 £550,000 £575,000 £600,000 £625,000 £650,000 £675,000 £700,000 £725,000 £750,000 £775,000 £800,000 £825,000 £850,000 £875,000 £900,000 £925,000 £950,000 £975,000 £1,000,000

Purchase Price: - Select - £50,000 £60,000 £70,000 £80,000 £90,000 £100,000 £110,000 £120,000 £130,000 £140,000 £150,000 £160,000 £170,000 £180,000 £190,000 £200,000 £210,000 £220,000 £230,000 £240,000 £250,000 £260,000 £270,000 £280,000 £290,000 £300,000 £310,000 £320,000 £330,000 £340,000 £350,000 £360,000 £370,000 £380,000 £390,000 £400,000 £410,000 £420,000 £430,000 £440,000 £450,000 £460,000 £470,000 £480,000 £490,000 £500,000 £510,000 £520,000 £530,000 £540,000 £550,000 £560,000 £570,000 £580,000 £590,000 £600,000 £610,000 £620,000 £630,000 £640,000 £650,000 £660,000 £670,000 £680,000 £690,000 £700,000 £710,000 £720,000 £730,000 £740,000 £750,000 £760,000 £770,000 £780,000 £790,000 £800,000 £810,000 £820,000 £830,000 £840,000 £850,000 £860,000 £870,000 £880,000 £890,000 £900,000 £910,000 £920,000 £930,000 £940,000 £950,000 £960,000 £970,000 £980,000 £990,000 £1,000,000

Monthly Mortgage Payment: - Select - None £50 £100 £150 £200 £250 £300 £350 £400 £450 £500 £550 £600 £650 £700 £750 £800 £850 £900 £950 £1,000 £1,100 £1,200 £1,300 £1,400 £1,500 £1,600 £1,700 £1,800 £1,900 £2,000 £2,100 £2,200 £2,300 £2,400 £2,500 £2,600 £2,700 £2,800 £2,900 £3,000 £3,500 £4,000 £4,500 £5,000 £5,500 £6,000 £6,500 £7,000 £7,500 £8,000

Date Of Purchased: dd 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 mm Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec yyyy 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 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

Had a Previous Mortgage? No Yes

If Yes To The Above, For How Many Years? - Select - < 1 year 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years 10 years 11 years 12 years 13 years 14 years 15 years 16 years 17 years 18 years 19 years 20 years 21 years 22 years 23 years 24 years