Name           D/O/B (dd/mm/yy)

Address Town/City Post Code

Marital Status: Married  Single  Divorced  Separated Number Of Dependant Children:

Home Phone (incl. STD) Work Phone Ext.

Previous Addresses (if less than 3 years at current Address N.B. list last 3 years addresses)
yrs yrs

DETAILS OF PROPERTY AND EMPLOYMENT

Living Status Owner  Tenant  Living with ParentsRent/Mortgage Payment  £

Employers Name Address

How long Employed yrs mthsOccupation

Previous Employment (if less than 3 years at current employment)

Previous Employers Name Address

How long Employed there  yrs mthsPrevious Occupation

Gross  Net  
Your Average Income      Week Month Year

Other Family Income   Week Month Year

Source of Other Family Income
 

    Printed Payslips  Yes No         Full Licence Yes No        Incurrent Address Yes No

Data Protection Act

 You acknowledge that before granting credit we may search the files of one or more credit reference agencies which will keep a record of our enquiry. We may also disclose details of the account and your conduct of it to that agency (or agencies). Information thus held is used only to help make credit decisions affecting you or members of your household or occasionally for fraud prevention or tracing debtors.