Halifax for Intermediaries Form

Intermediary mortgage data capture form www. halifax-intermediaries. co. uk w Number of applicants Is this a remortgage Yes No Do you require a KFI from Halifax Level of service for this application Advised Fee 1 C S AP LIEN UB P w. T M ha LIC S IT Y A M lif ax TIO O OU R R -in te N O TG A rm ed NLI GE iar NE ie s. c o. uk Fee 2 Fee 3 Fee type Amount of fee How much of the fee is refundable When payable On application Within 14 days completion On cancellation Personal details Applicant 1 Title Mr/Mrs/Miss/Ms/Dr/Other Forename 1 as shown on id Surname Male Female Married/Civil partnership Single Widowed Gender Divorced/Dissolved Civil partnership Date of birth Marital status Has your name ever changed Separated Previous first name Previous middle name Previous surname How many dependent children do you have total for all applicants Nationality Country of residence Do you have diplomatic immunity Work telephone number Home telephone number Mobile number Preferred contact number Work Home Mobile Home email address Work email address Halifax do not accept applications where the customer benefits from diplomatic immunity. Special needs Large print Braille Audio text Current address Postcode Has your address changed in the last 3 years Date moved into current address Customer information Customer type First time buyer Remortgage Existing Halifax Borrower Home Mover Remortgage own conveyancer Will the existing mortgage be repaid within one month of completion Residential status Home owner mortgage Renting Family/Friend First previous address in last 3 years Date moved out of previous address Home Owner Home Owner owned outright Second previous address in last 3 years Money laundering Was the verification taken Face to face Applicant identification Type of standard verification provided Document reference Date of issue Issuing office/organisation Type of secondary verification provided Employment details What type of occupation are you in e*g* Sales office professional trades Employment type PAYE Self employed Contract type Permanent Probationary Piecework Sub-contract Seasonal/Temp Fixed/short term Agency Start date of employment Percentage of business owned Anticipated age of retirement Retirement annual income Employer s/business telephone number Name of employer/business Do you have income from any other sources If Yes please complete the Other Income section on page 4. Income Gross annual income Annual commission Annual bonus Annual overtime Net profit latest year Net profit previous year if applicable Net profit 2nd previous year if applicable What year did you acquire an interest in the business In what year was the business established accounts Name of accountant s firm Accountant s address Accountant s telephone number What type of employment was this End date of employment If total employment history is still less than 18 months please complete section 2 on page 10. Other income What type of income is this Annual amount Scheme s required Shared equity Right to buy Shared Ownership What equity stake will be held by the customer Monthly Interest payments Second home loan Newbuy/MI New Home What percentage share will be purchased Monthly rental commitments Name of shared ownership company Loan details Purchase price/valuation Market value right to buy Cost of improvements Loan amount Total value of cash incentives Terms years Total value of outstanding mortgages with Lloyds Banking Group* Source of deposit Builder/Seller Concessionary Equity Gift Homebuy Housing Assoc or RSL Loan Savings Tenants Incentive Scheme Repayment type None Interest only Part interest only and part repayment Give details of new or existing plans or policies to be used with the interest only part of this Stocks Endowments Shares ISA Unit Trusts/ Open Ended Investment Companies Investment UK Bonds Sale of other residential property Shares Pensions Please also complete Other residential property form for each property.