Intermediary Details

If this is the first time you are submitting an enquiry through Zebra Homeloans you need to supply details about yourself. If you already have an intermediary account with us then simply login first and you will not need to complete these details.

Company Name:*
Contact Name:*
Address:*
Town:*
County:
Postcode:*
Main Phone No:*
E-mail Address:*
FSA Reg No:*

Applicant Details

		Applicant One		Applicant Two
Title
Forename*
Surname*
Maiden Name
Date of Birth*		/ / (DD/MM/YYYY)		/ / (DD/MM/YYYY)
Marital Status
Nationality
UK Resident		Yes No		Yes No
Current Address*
Postcode*
Time at Address		years months		years months
Residential Status
Previous Address* If less than 3 years at current address, give addresses for last 3 years
Postcode
Job Type		Employed (Full Status) Employed (Self Certification) Self-Employed (Full Status) Self-Employed (Self Certification) Retired or N/A		Employed (Full Status) Employed (Self Certification) Self-Employed (Full Status) Self-Employed (Self Certification) Retired or N/A

Loan Details

Loan Required:*		£
Purchase Price/Value:*		£
Loan Type:*		Residential Purchase (First Time Buyer) Residential Purchase (Existing Borrower) Residential Remortgage Buy to Let Purchase (First Time Buyer) Buy to Let Purchase (Existing Borrower) Buy to Let Remortgage Let to Buy Residential Right to Buy Purpose of Re-mortgage (complete for Re-mortgages only):
Property Type:*		House House (ex Local Authority) Flat Flat (ex Local Authority)
Term:*		years
Current Mortgage:		£
Existing Lender:

Additional Information:

Declaration: I am authorised to act as agent for and on behalf of ALL applicants in connection with this mortgage application.I confirm that I am acting within my authority and that I have obtained the verbal consent of each and every applicant that,in relation to the applicants personal information you may:-

1.Process it (automatically or otherwise)for the purposes of this application;
2.Search and/or disclose it to credit reference agencies, lenders and/or third parties provided they use it for the purposes for which you may use it for fraud prevention;
3.Where a search and /or disclosure is to a credit reference agency, the applicants understand that records may be kept;
4.Check it with a fraud prevention agency and if false or inaccurate information is provided or you suspect fraud,this will be recorded.

I confirm that I have explained to the applicants that you and other organisations may use and search the records of fraud prevention agencies to help make decisions about credit related services, and /or on motor, household,credit,life and other insurance proposals and claims for the applicants or members of their household; to trace debtors,recover debt,prevent fraud and to manage the applicants accounts or insurance policies and to check the applicants identity to prevent money laundering,except where satisfactory proof of identity has been provided.

The applicants understand that you may wish to obtain personal information(the accuracy of which is their responsibility)in writing,by telephone or in electronic form and agree that you may also obtain information about them from brokers or other third parties together with credit reference agencies,in particular,but not limited to,Experian,CAIS,Cifas,Equifax Europe,Insight and other associated companies.The applicant has been advised of their rights under the Data Protection Act 1998;that you will hold the personal information in your records and the applicants have the right to obtain a copy on payment of a fee.The applicants understand that any telephone calls made may be recorded and monitored for security,quality and /or training purposes.