Lennox Estates, Auctioneers, Valuers, Estate Agents, Property Consultants

New Developments

	Short Form Home Loan Application Form PLEASE NOTE THIS IS A € FORM All Financial Information should be entered in € Euros
Branch	Agency Code	REA Ref#
Purpose of this Mortgage Application:

PERSONAL DETAILS

Your email address:

Mother's Maiden Name (for security)

Principal Applicant
	Title
	First name
	Surname
	Address
	Residential status
Male Female	Sex
	Marital status
(dd/mm/yyyy)	Date of birth
	No of children
	Home phone
	Work phone
	Mobile

Joint Applicant

Male Female

(dd/mm/yyyy)

EMPLOYMENT DETAILS

Principal applicant
	Employment status
	Employer's name
	Employer's address
	Occupation
(dd/mm/yyyy)	Date employment commenced

Joint applicant

(dd/mm/yyyy)

PAYE INCOME DETAILS

Principal applicant
€	Base monthly salary (gross)
€	Base monthy salary (net)
€	Other income (gross)
€	Other income details

Joint applicant

€

SELF EMPLOYED DETAILS

Principal applicant
	Company name
	Address
	Nature of business
(dd/mm/yyyy)	Date established
	% shareholding

Joint applicant

(dd/mm/yyyy)

COMMITMENTS

Please complete the following in respect of all current financial commitments

Principal applicant
		Mortgage lender
€	Original mortgage amount/Limit
Balance outstanding	Monthly payment
€	€	Mortgage
€	€	Loans
€		Credit card

Joint applicant

€
Balance outstanding	Monthly payment
€	€
€	€
€

CREDIT HISTORY
Have you ever been declared bankrupt or insolvent, had a judgement registered against you, or made an arrangement with creditors, or have any judgements been registered against any company of which you are/were a director?
Principal applicant Yes / No	Joint applicant Yes / No

ASSETS
Please complete the following in respect to all assets (if space provided is insufficient, please schedule in notes area at the end of this form)
Type	Address	Year purchased	Original cost	Current value
Property 1			€	€
Property 2			€	€
Savings		(Institution/Description)		€

MORTGAGE LOAN DETAILS
Mortgage Loan Required: €	Term (5 to 30 years)
Method of repayment:
Interest rate type:	Fixed rate term Years (1,3,5 or 10)
* Please give details

PROPERTY TO BE MORTGAGED
What is the current market value of the property?	€
Type of property

DETAILS OF YOUR PURCHASE
Cost	Financed by
Purchase price/Valuation €	REA Loan	€
Additional comments	Cash/Savings	€

REA is a multi-agency intermediary regulated by the Central Bank of Ireland. REA is an approved Insurance Intermediary as regulated under the Insurance Act 1989 and authorised by the IICB to arrange insurance products.


	Lennox Estates, 81 Main Street, Bray, Co. Wicklow Tel: 01 2868275 Fax: 01 2829991 Email: info@lennoxestates.com