Intermediary mortgage
data capture form
Submit your client’s mortgage application online intermediary.tsb.co.uk
Broker Name
User ID
FCA Number
Contact Number
Number of applicants
Is this a remortgage?
Yes
No
Level of service for this application
Advised
Execution only
Level of service – execution only rationale
High net worth
Mortgage professional
Intermediary fees
Fee type
Fee 1
Rejected advice
Non-interactive sale
Fee 2
Fee 3
Amount of fee
£
£
£
£
£
How much of the fee is refundable?
£
When payable
On application
On application
On application
Within 14 days completion
Within 14 days completion
Within 14 days completion
On cancellation
On cancellation
On cancellation
On completion
On completion
On completion
Personal details
Title Mr/Mrs/Miss/Ms/Dr/Other
Applicant 1
Applicant 2
Forename 1 – as shown on id
Forename 1 – as shown on id
Forename 2 – as shown on id (if applicable)
Forename 2 – as shown on id (if applicable)
Forename 3 – as shown on id (if applicable)
Forename 3 – as shown on id (if applicable)
Surname
Surname
Gender
Gender
Male
Date of birth
Female
Male
(DD/MM/YYYY)
Date of birth
1
Female
(DD/MM/YYYY)
Personal details (continued)
Applicant 1
Applicant 2
Marital status
Marital status
Married/Civil partnership
Widowed
Single
Separated
Married/Civil partnership
Divorced/Dissolved Civil partnership
Widowed
Has your name ever changed?
Yes
Single
Has your name ever changed?
No
Yes
No
Previous first name
Previous first name
Previous middle name
Previous middle name
Previous surname
Previous surname
How many dependent children do you have?
Nationality
Nationality
National Insurance Number
National Insurance Number
Dual Nationality
Dual Nationality
Country of residence
Country of residence
Do you have diplomatic immunity?*
Do you have diplomatic immunity?*
Yes
No
Yes
No
Work telephone number
Work telephone number
Home telephone number
Home telephone number
Mobile number
Mobile number
Preferred contact number
Preferred contact number
Work
Home
Mobile
Work
Home
Home email address
Home email address
Work email address
Work email address
Special needs
Special needs
Large print
Braille
Audio text
Large print
Current address
Braille
Postcode
Yes
Mobile
Audio text
Current address
Postcode
Has your address changed in the last 3 years?
Has your address changed in the last 3 years?
No
Yes
Date moved into current address
No
Date moved into current address
* TSB do not accept applications where the customer benefits from diplomatic immunity.
2
Separated
Divorced/Dissolved Civil partnership
Customer information
Applicant 1
Customer type
Applicant 2
Customer type
First time buyer
Home Mover
Remortgage
Existing TSB Borrower
First time buyer
Remortgage – own conveyancer
Home Mover
Will the existing mortgage be repaid within one month of completion?
Yes
Remortgage
Existing TSB Borrower
Remortgage – own conveyancer
Will the existing mortgage be repaid within one month of completion?
No
Yes
Residential status
No
Residential status
Home owner – mortgage
Renting
Home owner (mortgage free)
Home owner – mortgage
Family/Friend
Renting
Home owner (mortgage free)
First previous address in last 3 years
Family/Friend
First previous address in last 3 years
Postcode
Postcode
Date moved into previous address
Date moved into previous address
Date moved out of previous address
Date moved out of previous address
Residential status
Residential status
Home owner – mortgage
Renting
Home owner (mortgage free)
Home owner – mortgage
Family/Friend
Renting
Home owner (mortgage free)
Second previous address in last 3 years
Family/Friend
Second previous address in last 3 years
Postcode
Postcode
Date moved into previous address
Date moved into previous address
Date moved out of previous address
Date moved out of previous address
Residential status
Residential status
Home owner – mortgage
Renting
Home owner (mortgage free)
Home owner – mortgage
Family/Friend
Renting
Home owner (mortgage free)
Family/Friend
Money laundering
Was the verification taken?
Face to face
Was the verification taken?
Non Face to face
Face to face
Non Face to face
Applicant identification
Applicant identification
Applicant 1
Applicant 2
Type of standard verification provided
Type of standard verification provided
Document reference
Document reference
Date of issue
Date of issue
3
Money laundering (continued)
Applicant 1
Applicant 2
Issuing office/organisation
Issuing office/organisation
Type of secondary verification provided
Type of secondary verification provided
Document reference
Document reference
Date of issue
Date of issue
Issuing office/organisation
Issuing office/organisation
Employment details
Applicant 1
Number of jobs per applicant
Applicant 2
Number of jobs per applicant
What type of occupation are you in? e.g. Sales, office, professional, trades
What type of occupation are you in? e.g. Sales, office, professional, trades
Employment type
Employment type
PAYE
Self employed
PAYE
Contract type
Permanent
Self employed
Contract type
Probationary
Seasonal/Temp
Piecework
Fixed/short term
Sub-contract
Permanent
Agency
Probationary
Seasonal/Temp
Fixed/short term
Start date of employment
Start date of employment
Percentage of business owned
Percentage of business owned
%
%
Anticipated age of retirement
Anticipated age of retirement
Type of anticipated retirement annual income
Type of anticipated retirement annual income
Anticipated retirement annual income
Anticipated retirement annual income
£
£
Frequency of anticipated retirement annual income
Frequency of anticipated retirement annual income
Type of anticipated retirement annual income
Type of anticipated retirement annual income
Anticipated retirement annual income
Anticipated retirement annual income
£
£
Frequency of anticipated retirement annual income
Frequency of anticipated retirement annual income
4
Employment details (continued)
Applicant 1
Applicant 2
Name of employer/business
Name of employer/business
Employer’s/business address
Employer’s/business address
Postcode
Postcode
Employer’s/business telephone number
Employer’s/business telephone number
Employer’s/business fax number
Employer’s/business fax number
Do you have income from any other sources?
Do you have income from any other sources?
Yes
No
Yes
No
(If ‘Yes’, please complete the ‘Other Income’ section on page 7.)
(If ‘Yes’, please complete the ‘Other Income’ section on page 7.)
Income
Basic annual income
Income
Basic annual income
£
Can income be verified?
Yes
No
Yes
No
£
Annual commission
£
£
No
Yes
No
Yes
No
Yes
No
Annual bonus
Yes
No
£
Annual overtime
£
Yes
Annual commission
Annual bonus
£
Can income be verified?
Annual overtime
Yes
No
£
If self-employed
Latest year
Year end date
If self-employed
Latest year
Year end date
Turnover (£)
Turnover (£)
£
£
Gross profit (£)
Gross profit (£)
£
£
Net profit (£)
Net profit (£)
£
£
Assets (£)
Assets (£)
£
£
Liabilities (£)
Liabilities (£)
£
£
Previous year
Year end date
Previous year
Year end date
Turnover (£)
Turnover (£)
£
£
Gross profit (£)
Gross profit (£)
£
£
5
Employment details (continued)
Applicant 1
Applicant 2
Net profit (£)
Net profit (£)
£
£
Assets (£)
Assets (£)
£
£
Liabilities (£)
Liabilities (£)
£
£
2nd previous year
Year end date
2nd previous year
Year end date
Turnover (£)
Turnover (£)
£
£
Gross profit (£)
Gross profit (£)
£
£
Net profit (£)
Net profit (£)
£
£
Assets (£)
Assets (£)
£
£
Liabilities (£)
Liabilities (£)
£
£
Projected year
Year end date
Projected year
Year end date
Turnover (£)
Turnover (£)
£
£
Gross profit (£)
Gross profit (£)
£
£
Net profit (£)
Net profit (£)
£
£
Assets (£)
Assets (£)
£
£
Liabilities (£)
Liabilities (£)
£
£
What year did you acquire an interest in the business?
What year did you acquire an interest in the business?
In what year was the business established?
In what year was the business established?
Does the business have accounts?
Does the business have accounts?
Yes
No
Yes
No
Name of accountant’s firm
Name of accountant’s firm
Accountant’s address
Accountant’s address
Postcode
Postcode
6
Employment details (continued)
Applicant 1
Applicant 2
Accountant’s telephone number
Accountant’s telephone number
Name of previous employer/business
Name of previous employer/business
Previous employer’s/business address
Previous employer’s/business address
Postcode
Postcode
Previous employer’s/business telephone number
Previous employer’s/business telephone number
Previous employer’s/business fax number
Previous employer’s/business fax number
What type of employment was this? e.g. Sales, office, professional, trades
What type of employment was this? e.g. Sales, office, professional, trades
Start date of employment
Start date of employment
End date of employment
End date of employment
(If total employment history is still less than 18 months, please complete section 2 on page 15.)
Other income
Applicant 1
Applicant 2
What type of income is this?
What type of income is this?
Annual amount (£)
Annual amount (£)
£
£
What type of income is this?
What type of income is this?
Annual amount (£)
Annual amount (£)
£
£
Scheme(s) required
Right to buy
Second home loan
Shared equity
Shared Ownership
Shared equity
What equity stake will be held by the customer?
Shared ownership
What percentage share will be purchased?
%
%
Monthly interest payments
Monthly rental commitments
£
£
Name of shared ownership company
7
Loan details
Purchase price/valuation
£
Market value (right to buy)
£
Cost of improvements
£
Loan amount
£
Total value of cash incentives
£
Builder/Seller
Concessionary
Savings
Tenants Incentive Scheme
Equity
Gift
Homebuy
Housing Assoc or RSL
Loan
None
Loan details
Provide breakdown of the mortgage required. Parts 2 and 3 are where multiple products, terms or repayment types are required.
Part 1
Part 2
Part 3
Product code (if known)
Product code (if known)
Product code (if known)
Type of product e.g. fixed, tracker
Type of product e.g. fixed, tracker
Type of product e.g. fixed, tracker
Interest rate charged
Interest rate charged
Interest rate charged
Product term/end date
Product term/end date
Product term/end date
Loan amount
Loan amount
Loan amount
£
£
£
Loan term (years)
Loan term (years)
Loan term (years)
Repayment type
Repayment type
Repayment type
Purpose
Purpose
Purpose
What is your preferred payment date?
8
Product details (continued)
Interest only amount
Give details of new or existing plans or policies to be used with the interest only part of this mortgage.
Endowments
£
Sale of other
residential
property –
Unit Trusts/
Open Ended
Investment
Companies
(UK)
Stocks &
Shares ISA
Investment
Bonds
Stocks &
Shares
Pensions
Please also
complete Interest
only – Other
residential property
form for each
property.
Total
£
£
£
£
£
£
£
£
£
£
£
£
£
£
Monthly premium
£
Reference/Account number
Maturity date for each repayment vehicle
Personal finances (both applicants)
Time with bank
Applicant 1
Years
Applicant 2
Years
Months
Months
Credit commitments
(These include finance commitments like credit cards, charge cards, store cards, overdrafts, loans, hire purchase payments, mail order, and buy now pay later arrangements. They also include
commitments like child maintenance payments, student loan repayments, child care costs, school or university fees and any significant hobby costs that the applicant does not wish to stop.)
Type of commitment
Commitment 1
Commitment 2
Commitment 3
Commitment 4
Commitment 5
Whose name is commitment in?
Name of lender/company
Monthly repayment
£
£
£
£
£
£
£
£
£
D D M M Y Y Y Y
D D M M Y Y Y Y
D D M M Y Y Y Y
D D M M Y Y Y Y
Balance outstanding
£
End date of loan
D D M M Y Y Y Y
Number of months in arrears
Will this be repaid on completion in full?
Yes
No
Yes
No
Yes
No
If yes, source of funds to repay
Total monthly maintenance payments
£
9
Yes
No
Yes
No
Personal finances (both applicants) (continued)
For mortgage commitments only, complete the information below:
Mortgage type
Remaining term
Repayment type
Name of lender/company
Monthly repayment
£
Balance outstanding
£
End date of loan
Current months in arrears
Intend to repay on completion
Yes
No
Source of repayment
Second home monthly running costs
£
If you have additional mortgage commitments complete section 3 on page 15.
Have any future known changes to income/expenditure been taken into account?
Yes
No
Financial history
Has any applicant been in arrears in the last 6 years with any borrowing or ever had a property repossessed?
Yes
No
Has any applicant had a County Court judgment (CCJ) or default registered against them or if self-employed against their business within the last 6 years?
Yes
No
Has any applicant been declared bankrupt, entered into an IVA or debt relief order within the last 6 years or still have an outstanding bankruptcy restriction order?
Yes
No
Property information
Postal address of the property
Postcode
Property
What type of property is this?
House
Bungalow
Converted flat
Purpose built flat
Detached
Semi detached
End terrace
Mid terrace
No of bedrooms
If the property is a flat, number of floors in the block
10
Other
Property information (continued)
Which floor is the flat on?
Purchase type
Normal
Sitting tenant
Inheritance
Gift
Other
Local authority
Was the property built in the last 12 months?
Yes
No
Year property built
Property to be occupied for the first time in its current state?
Yes
No
Builder’s name
If a new property is being purchased, please confirm the building standards indemnity scheme
NHBC
Zurich Municipal
Consultant Monitored
Premier Guarantee/Liberty Legal
Building Lifeplans/Allianz Global Risks
CRL
LABC New Homes Warranty
LABC Hallmark Warranty
Buildzone
Other
None
Investment Club
Normal
Local Authority
New Town Corporation
Housing Assoc.
The Coal Authority
Builder/developer
TSB selling as possessor
Who is selling the property ?
Name
Do you currently own the property?
Yes
No
Do you currently live at the property?
Yes
No
Will anyone else (aged 17 or over) live at the property?
Yes
No
Occupation within 12 months
All
Part
None
Will business be carried out at this property?
Yes
No
Legal title
What is the tenure of the property?
Freehold
Leasehold
Common hold
Ownership Interest
Remaining term of lease (if leasehold)
How much will the following be? (if applicable)
Annual ground rent
£
Annual service charge
Annual chief rent or feu duty (Scotland)
£
£
Entry date – Scotland only
Type of initial occupancy property
New build
Refurbishment
Conversion
11
Remortgage details
(only to be completed for remortgage applications)
Original purchase price
£
Lender’s name
Mortgage account number
Outstanding mortgage amount
£
Please provide details of any improvements you have made to the property (including estimated costs)
Has your home or nearby building been damaged by subsidence, heave, landslip or does it show any signs of cracking or bulging of walls?
Yes
No
Accommodation
Please provide the following details about the property
Number of bedrooms
Number of bathrooms
Number of living rooms
Number of separate toilets
Number of habitable rooms
Does the property have:
Central heating
Full
Part
None
Electricity
Oil
Central heating type
Gas
Solid Fuel
A conservatory
Yes
No
How many cars can be garaged?
Off road parking
Yes
No
A garden
Yes
No
No. of acres
Road charge liability Is there any other secured lending on the property?
Yes
No
Reason for remortgage
Remortgage only
Remortgage & home improvements
Remortgage & debt consolidation
Other
Remortgage home improvements & debt consolidation
12
Other
Other secured lending
Name of lender
Loan 1
Loan 2
Loan 3
Account number
To be repaid or postponed
Repaid
Postponed
Repaid
Postponed
Repaid
Postponed
No
Yes
No
Customer advised if deed of postponement or ranking agreement needed
Yes
No
Yes
Other occupants
Please give the names of anybody aged seventeen or over and not party to the mortgage who will live at the property.
Forename(s)
Surname
Forename(s)
Surname
Valuation details
Valuation type
Valuation
Survey and Valuation
Building Survey and Valuation
Access to the property
The keys can be obtained from:
Name
Telephone number
Evening telephone number
Selling agent (if different)
Selling agent’s telephone number
Extension
Other contact details
13
Remortgage Valuation
Conveyancer’s details
Are you using your own conveyancer?
Yes
No
Name of firm
Address
Postcode
Who is acting for you?
Telephone number
Fax number
Supporting information
If you want to provide any additional information to support your application, please use the section below.
Section 1 Additional information on previous addresses
14
Supporting information (continued)
Section 2 Additional information on current/previous employers
Section 3 Additional information on mortgage commitments
Mortgage type
Remaining term
Repayment type
Mortgage lender
Monthly running cost
£
Monthly payment
£
Outstanding balance
£
End date
Current months in arrears
Intend to repay on completion
Yes
No
Source of repayment
15
Supporting information (continued)
Section 4 Any other information you feel we might need to know to help us assess your application for a mortgage, in particular, if the loan extends
beyond retirement age. Please confirm how you intend to maintain payments.
16
Easy ways to make your payments
For your convenience monthly payments will be made from a bank/building society using direct debit. Please complete the section below.
Payment mandate
Instructions to your bank or building society
to pay direct debits
Originator’s Identification Number
8 8 3 0 0 8
To: The Manager
Bank or Building Society
Address
Postcode
Please pay TSB Direct Debits from the account detailed on this Instruction subject to
the safeguards assured by The Direct Debit Guarantee.
I understand that this instruction may remain with TSB and, if so, details will be passed
electronically to my Bank/Building Society.
Signature(s)Date
Name of account holder(s)
Bank or Building Society
account number
Branch sort code
TSB Bank plc reference number
Banks and Building Societies may not accept Direct Debit Instructions for some types of accounts.
!
Please retain this section for your information
The Direct Debit Guarantee – this should be retained
• This Guarantee is offered by all Banks and Building Societies that take part in the Direct Debit Scheme.
The efficiency and security of the scheme is monitored and protected by your own Bank or Building Society.
• If the amounts to be paid or the payment dates change, TSB will notify you 10 working days in advance of your
account being debited or as otherwise agreed.
• If an error is made by TSB Bank plc, or your Bank or Building Society, you are guaranteed a full and immediate
refund from your branch of the amount paid.
• You can cancel a Direct Debit at any time by writing to your Bank or Building Society. Please also send a copy
of your letter to us.
17
THIS PAGE SHOULD BE READ AND RETAINED BY ALL CUSTOMERS
Customer confirmation
If I apply for a mortgage I confirm that I make the following statements:
I declare that:1. I apply for a loan on the security of the property described in this application;
2. I believe the information given in this application is correct.
I authorise you to:3. Make any enquiries of any third parties for reference purposes and for the third party to disclose any information to you;
4. Change the address on all my accounts held with you.
I agree that:5. I will notify you of any changes in circumstances relating to my purchase or mortgage before it is entered into and I authorise my
conveyancer to disclose such information to you;
6. Where I am making this application with one other joint applicant (but not more than one other), following completion you may
act on the request of either of us for a payment arrangement, payment holiday or the release of any retained funds or drawdown
of reserve/credit available under the mortgage. I also agree that such a request may be made in person, in writing, by telephone
or online.
7. If I borrow and do not repay in full and on time, you may tell credit reference agencies who will record the outstanding debt and my
details may be submitted to the Council of Mortgage Lenders possessions register;
8. I have received information explaining property assessments.
I understand that:9. The payment of any fees is non-refundable and shall not mean that you have to make an advance;
10.If I/we choose a Homebuyers Survey and Valuation Report, you will choose the valuer for the property assessment and that it is the
valuer’s responsibility to agree the Conditions of Engagement for the private survey element with me;
Data protection notice
Your information will be held by TSB Bank plc.
More information can be found at tsb.co.uk
We will share your personal information from your application with fraud prevention agencies. If false or inaccurate information is
provided and fraud is identified, details of this fraud will be passed to these agencies to prevent fraud and money laundering. Further
details explaining how information held by the fraud prevention agencies may be used can be obtained by reading the privacy notice at
tsb.co.uk or contacting your local branch.
We may obtain information about you from credit reference agencies, fraud prevention agencies, and Group records to check your
credit status and identity. The agencies will record our enquiries which may be seen by other companies who make their own credit
enquiries. This may affect your ability to obtain credit elsewhere in the near future. We may also use credit scoring.
Your application will be assessed using credit reference agency records relating to you and anyone with whom you have a joint
account or similar financial association. If this is a joint application and such a link does not already exist then one may be created now.
These links will remain until you successfully apply for a “notice of disassociation” at the credit reference agencies.
If you are providing information on behalf of a joint applicant, by continuing with this application you confirm that you have their
permission to do so and they have agreed that we are authorised to search, link and record information about them at credit
reference agencies.
We may ask you to provide physical forms of identity verification when you open your account. Alternatively, we may search credit
reference agency files in assessing your application. The agency also gives us other details and information from the Electoral Register
to verify your identity. The agency keeps a record of our search, whether or not your application proceeds. Our search is not seen or
used by lenders to assess your ability to obtain credit.
Under the Data Protection Act you have the right of access to your personal data. The Act allows us to charge a fee of £10 for this
service. If anything is inaccurate or incorrect, please let us know and we will correct it.
TSB may use your information to contact you by mail, telephone, email or text message about products and services that may be of
interest to you. If you do not wish to receive this information please contact your local branch or visit tsb.co.uk for details of how to opt
out of this service.
It is important that you understand how the personal information you give us will be used. Therefore, we strongly advise that you read
our Privacy Statement, which you can find at tsb.co.uk or you can ask us for a copy. By applying for a mortgage, you agree to your
personal information being used in the ways we describe in our Privacy Statement. Please let us know if you have any questions about
the use of your personal information.
18
Remortgage customer authority (where applicable)
1. I authorise you or any conveyancers acting for you in connection with the proposed remortgage of my property:
• to obtain the title deeds to the property;
• to obtain a repayment figure from my/our current lender(s).
2. I confirm that I will make my own enquiries about and pay any fees or charges made by my current lender in connection with
the repayment of my existing mortgage (including any administration fees made in respect of sending the title deeds to your
conveyancer and providing a repayment figure and any fees in connection with my existing mortgage).
3. I understand that your conveyancer is only representing you and that if I want independent legal advice at any stage of this
transaction I will obtain and get it myself.
4. I understand that you may not arrange for an inspection of the property to be carried out. I further understand that you will not
routinely tell me what your assessment of the value of the property is.
I understand that, if you are prepared to make me a loan, I must not rely upon any assessment made as an indication of the value of the
property. You have informed me and I accept that, if I require any information about the value or condition of the property or about any
health and safety issues, it is my responsibility to obtain independent advice before I go ahead with the remortgage of the property.
Land registry
I authorise your conveyancer to obtain copies of any document held at any of the land registries in England and Wales and Scotland.
19
If you’d like this in another format such as large print, Braille or audio
please contact your Business Development Manager.
Important information.
You must be at least 18 years old to take out a loan with us. Before agreeing a loan we will want to satisfy ourselves about the suitability of your
application, which will include assessing your ability to afford the payments and, normally, valuing the property.
Calls may be monitored or recorded. If you need to call us from abroad, or prefer not to use our 0345 number, you can also call us on 0203 384 1575.
Not all Telephone Banking services are available 24 hours a day, seven days a week. Please speak to an adviser for more information.
TSB Bank plc. Registered Office: Henry Duncan House, 120 George Street, Edinburgh EH2 4LH. Registered in Scotland no. SC95237. Authorised by
the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority under registration number
191240. TSB Bank plc is covered by the Financial Services Compensation Scheme and the Financial Ombudsman Service.
TSB10499 (03/15)
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