Introducer Referral Form

Section 1

Loan Details
Amount required (£)
Term required
Purpose of loan
How would you like Loan Options to proceed? I have limited information about my client and I would like Loan Options to contact my client directly and handle the whole process on my behalf, whilst keeping me fully informed with automatic status update notifications. I would like a fully underwritten DIP and a quote summary for my client. Loan Options will advise you directly of the products available to your client before progressing the referral further.

Applicant Details
Title
Date of birth
First names
Surname	*
Maiden name
Marital status
Contact Details
Home phone	*
Please ensure that you include all of your clients’ telephone numbers and they are correct as our systems may detect discrepancy between registered residential address and telephone number, which could in turn result in automatic lender rejection through our sourcing system when cross-referencing takes place. It is essential that you complete these fields as some lenders may also reject a case if the applicant has no land line number at all.
Mobile phone
Email address
Work phone
Applicant Address
Address

City
County
Postcode
Time at address	years months

Previous Address
Address

City
County
Postcode
Time at address	years months

2nd Previous Address
Address

City
County
Postcode
Time at address	years months
Is this the property that the loan will be secured against?

Secured Property Address
(address of the property that the loan will be secured against)
Address

City
County
Postcode
Time owned property	years months

Notes

Data Protection & Credit Check
Read and agree to the Data Protection Act [ YOU MUST TICK THIS BOX FOR THIS APPLICATION TO BE SUBMITTED ]
You are currently opted in to the Loan Options EDP Whats This? Opt In


(This form may take a few moments to be submitted. Please be patient, and only click the submit button once. Thank You.)