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Gem mortgages
Please only complete this form if you are seeking mortgage advice and you are happy to be contacted by a qualified mortgage adviser. Once you have submitted the completed form a qualified mortgage adviser will review your details and contact you at a time convenient for yourself.
Applicant 1
*Full name
*Address Line 1:
Address Line 2
*Town/City
*County
*Postcode
*Telephone number
*Your email addressEmail
*Date of Birthformatt dd/mm/yyyy
*Planned retirement age
*Are you a UK resident?
Yes No 
*Occupation
*Annual income
*Work status
*Do you have payslips/accounts?
The following questions allow you to enter details of existing financial comittments.
*Total outstanding on loansIf none enter 0
*Total outstanding on credit cardsIf none enter 0
*Monthly credit card/loan paymentsIf none enter 0
*Do you have any CCJ`s or Defaults registered against you?
Yes No 
*Have you ever been registered Bankrupt?
Yes No 
Applicant 2 (only if applicable)
Full name
Date of Birthformatt dd/mm/yyyy
*Planned retirement age
Are you a UK resident
Yes No 
*Occupation
Annual income
Work status
Do you have payslips/accounts
The following questions allow you to enter details of existing financial comittments.
Total outstanding on loansIf none enter 0
Total outstanding on credit cardsIf none enter 0
Monthly credit card/loan paymentsIf none enter 0
Do you have any CCJ`s or Defaults registered against you?
Yes No 
Have you ever been registered Bankrupt?
Yes No 
Affordability
*Household monthly income (net)
Enter monthly spend on the following (Not including any loans entered above)
*Gas/Elec/Phone
*Insurance ie Life policiesIf none enter 0
*House insurance
*Food shopping
*Transport/CarIf none enter 0
*Savings plansIf none enter 0
*Leisure/Eating out etcIf none enter 0
Other
Your Requirements
*I require
*Deposit/Equity available
*Property market value
*Loan amount required
*What basis do you require loan on?
Interest only Repayment Part Int only/Part Rep Not sure 
*Rate preference
*Term (number of years)
*Initial deal period
Additional notes
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Thank you for taking the time to complete our enquiry form. Your information will be reviewed by a qualified mortgage adviser and input into our professional mortgage sourcing software. An adviser will call you back at a convenient time to look at the options with you and offer general advice and guidance.
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