Loan Application
Loan Amount
Purpose of Loan
Repayment Period
Credit Rating
Title
First Name
Last Name
Date of birth
Email
Home Tel
Mobile Tel
Time to Contact
Country of Residence
Status
House Number
House/Flat name
Street
Area
Town
County
Postcode
Residential Status
At current address since...
Employment Status
Annual Income
Are your wages paid directly
into your bank account?
Yes  No 
Have you ever been
declared bankrupt?
Yes  No 
Have you ever been in a
debt management programme?
Yes  No 
If required, could you get
a guarantor for the loan?
Yes  No