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Name of the Applicant
Loan Amount
Loan Purpose
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New Car Purchase
Home Improvements
Holiday
Pay off loans
Credit cards
Other
Loan Term
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3 years(36 months)
5 years(60 months)
7 years(84 months)
9 years(108 months)
11 years(132 months)
13 years(156 months)
15 years(180 months)
17 years(204 months)
19 years(228 months)
21 years(252 months)
23 years(276 months)
25 years(300 months)
Employment
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Employed over 16 hours
Employed under 16 hours
Self-employed
Company Director
Do You Have a mortgage?
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Yes
No
Do You Have a Good
Credit History?
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Yes
No
Marital Status
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Single
Married
Living with Partner
Seperated
Divorced
Widowed
PPP
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Cover for just myself
Cover for myself and partner
Living with Partner
No cover
Accomodation
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Private Purchase
Council Purchase in last 3 years
Council purchase above 3 years
Tennant
Living with parents/family
Mortgage Payer
Homeowner
Time at address
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longer than 3 years
Less than 3 years
Home Telephone
Mobile Telephone
Email Address
House Name/No
County
Postcode
Date of birth
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JAN
FEB
MAR
APR
MAY
JUN
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AUG
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OCT
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DEC
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