Access Broker Services

Online Application Form

Broker Details			Required
Name			•

Loan Requirements			Required
Amount Required	£		•
Term Required			•
Payment Protection (PPI) Required		: Single : Joint : Not Required
Loan Purpose

Your Details		Required
Number Of Applicants	: One : Two

Status	: Single : Living Together : Married : Divorced : Widowed / Separated	•

Title & Full Name - *Applicant One*		•
Date of Birth - *Applicant One*	(dd) (mm) (yyyy)	•

Title & Full Name - *Applicant Two*
Date of Birth - *Applicant Two*	(dd) (mm) (yyyy)

Current Address		•


Postcode		•
How Long Have You Lived At This Address?	Years Months	•
As Your Current Address Is Less Than 3 Years, Please Provide Previous Address Details.
Previous Address


Postcode
How Long Have You Lived At This Address?	Years Months

Home Telephone Number		•
Mobile Telephone Number - *Applicant One*		•
Work Telephone Number - *Applicant One*		•
E-Mail Addess - *Applicant One*

Mobile Telephone Number - *Applicant Two*
Work Telephone Number - *Applicant Two*
E-Mail Address - *Applicant Two*

Name Of Bank		•
How Many Years Have You Been With Your Bank?	Years	•

Number Of Dependants (Below 18 Years Of Age)

Property Details - Homeowners Only To Complete			Required
Type Of Property		: Detached : Semi-Detached : Terraced : Bungalow : Flat / Maisonette	•

Construction Type		: Standard : *Non-Standard*
If '*Non-Standard*', Please Provide Construction Type

Accommodation, Number Of		Bedrooms: Living Rooms: Kitchens: Bathrooms: WC's: Garages:

Shared Ownership		: Yes : No	•

Is Property Ex-Council?		: *Yes* : No	•
If '*Yes', Discount Given If Right-To-Buy (RTB)*	£

Date Purchased		(dd) (mm) (yyyy)	•
Purchase Price	£		•
Current Value	£		•

Employment Details			Required
Details For Applicant 1

Occupation			•

Employment Status		: Employed : *Self Employed* : Retired : Unemployed	•
If *'Self Employed'*, Do You Have Accounts?		: *Yes* : No : Not Applicable
If *'Yes'*, How Many Years Accounts Are Available?		Years

Time In Job		Years Months	•

Monthly Gross Income (Including Overtime & Bonus)	£		•
Details Of Other Income

Details For Applicant 2

Occupation

Employment Status		: Employed : *Self Employed* : Retired : Unemployed
If *'Self Employed'*, Do You Have Accounts?		: *Yes* : No : Not Applicable
If *'Yes'*, How Many Years Accounts Are Available?		Years

Time In Job		Years Months

Monthly Gross Income (Including Overtime & Bonus)	£
Details Of Other Income

Your Mortgage		Required
Name Of Mortgage Lender		•
Monthly Payment	£	•
Amount Owed	£	•
Name Of Previous Mortgage Lender If Changed In Last 12 Months

Existing Secured Loans

Required

Do You Have Any Existing Secured Loans?

: Yes : No

Existing Unsecured Loans & Credit Cards

Required

Do You Have Any Existing Unsecured Loans Or Credit Cards?

: Yes : No

Credit History

Required

Do You Have Any Adverse Credit History?

: Yes : No

Preferred Contact Details			Required
Applicant To Contact			•
Best Time To Contact Applicant(s)			•
Best Contact Number			•

Marketing Details			Required
Where Did You Hear About Our Company?
If You Have Selected *'Other'* Please Provide Details

Notes	Required

Declaration & Submission		Required
Declaration	DATA PROTECTION STATEMENT In dealing with Clover Mortgages Ltd. you have provided / may provide us with personal data about yourself. Clover Mortgages Ltd. is committed to following policies which protect your privacy and comply with current international data protection laws and regulations in respect of personal data. Please note that the information that you provide to us is passed directly to Access Loans & Mortgages group of companies and held on their computer systems; credit referencing agencies with whom they work and the lender who ultimately lends to you. Where we do pass data to third parties appropriate confidentiality arrangements are in place. Your personal data may be held and processed in connection with a transaction we look at with / for you, our normal general development of our business, and for administrative purposes relating to those activities. We reserve the right to hold this data until you indicate that you wish us to do otherwise. If you provide us with personal data in relation to a loan application, please note that you thereby consent to the following, which may entail the provision of your personal data to third parties: (1) Performing credit / authentication checks. (2) Taking up external references, including the use of referencing agencies. (3) Ongoing recording, processing and updating of personal data in the normal course of administration. (4) Disclosing the data to any other company within the lender's group of companies and / or to any third parties (for example: debt councillor and insurers) at any time for the purposes of assessing your application and administrating and enforcing any subsequent loan whether during the lifetime of any loan granted pursuant to such application. (5) Disclosing the data to any third party who replaces or may replace the original lender. (6) Obtaining and providing feedback of a formal and informal nature on individual performance as part of our ongoing commitment to improving our service. (7) Advising us in writing of any changes to your personal data. (8) Advising us in writing of any confidentiality issues which may arise as a result of the disclosure or processing of your personal data in the course of normal administration of the application. Apart from the above, we do not disclose your personal data to any third parties, except where you have given your consent or we have a legal obligation to do so. If false or inaccurate information is provided and fraud is identified, details will be passed to fraud prevention agencies. Law enforcement agencies may access and use this information. The Lender and other organisations may also access and use this information to prevent fraud and money laundering, for example, when: (1) Checking details on applications fro credit and credit related or other facilities. (2) Managing credit and credit related accounts or facilities (3) Recovering debt. (4) Checking details on proposals and claims for all types of insurance. (5) Checking details of job applicants and employees. Please contact the Lenders concerned if you want to receive details of the relevant fraud prevention agencies. The Lender and other organisations may access and use from other countries the information recorded by fraud prevention agencies.
	By Ticking Here You Confirm That You Have Read And Accept The DATA PROTECTION ACT 1998 Notice Above And Consent To It's Content: Think Carefully Before Securing Other Debts Against Your Home. Your Home May Be Repossessed If You Do Not Keep Up Repayments On Your Mortgage.	•