Amount to borrow* £     Term of loan*       Type of loan required   Secured loan Unsecured loan     Purpose of loan           1st Applicant   2nd Applicant (if applicable) First name*     Surname*     x Address*     Postcode*     Email Address*     Date of birth     Telephone*     Residential status   Home owner   Home Owner Tenant Living With Parents House bought from   Private Council   Private Council Employment status   Employed Self Employed Retired Unemployed   Employed Self Employed Retired Unemployed Occupation     Annual income £ £ House value £ £ Mortgage balance £ £ Mortgage company     Monthly mortgage repayment £ £   I have read and I accept the Data Protection Act statement__ _Yes__ _No                   THINK CAREFULLY BEFORE SECURING A LOAN AGAINST YOUR HOME, YOUR HOME MAY BE REPOSSESSED IF YOU DO NOT KEEP UP REPAYMENTS ON A MORTGAGE OR ANY OTHER DEBT SECURED ON IT.