| ASSET & LIABILITY STATEMENT |
| Name (1) |
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Name (2) |
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| Date of Birth |
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Date of Birth |
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| Dependants & age |
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Dependants & age |
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| Home Address |
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Home Address |
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| Telephone |
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Telephone |
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| Email |
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Email |
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| Occupation |
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Occupation |
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| Annual Salary |
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Annual Salary |
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| Other income- give details |
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Other income- give details |
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Give details (below) of existing property portfolio including main residence or attach a separate schedule.
Please state if owned other than in your own name. |
Address |
Value |
Loan outstanding |
Lender |
Purchase price & date |
Rental income |
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Assets |
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Liabilities |
| Savings / Credit balances |
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Personal overdraft |
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| Vehicles |
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Personal Loans |
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| Investment/ shares |
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Hire Purchase |
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Life Policies
A(Life cover
B)Surrender value |
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Credit Card |
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| Other assets |
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Other Financial Liabilities |
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| Liabilities of Adverse Credit |
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Declaration: I / We understand that you are relying on this information provided in deciding to grant facilities to the
undersigned. I / We certify that the information provided is true and correct. |
| Date: |