Mortgage intake form MORTGAGE INTAKE FORM Please complete the form as thoroughly as possible. We will contact you as soon as possible. GENERAL INFORMATION Applicant 1 First name Middle name (if applicable) Last name Address Street name and house number City / Place of residence Zip code County Select your country Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belau Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Saint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Cook Islands Costa Rica Croatia Cuba Curaçao Cyprus Czech Republic Democratic Republic of the Congo (Kinshasa) Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Ivory Coast Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao S.A.R., China Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palestinian Territory Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Republic of the Congo (Brazzaville) Reunion Romania Russia Rwanda Saint Barthélemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin (Dutch part) Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia/Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom (UK) United States (US) United States (US) Minor Outlying Islands United States (US) Virgin Islands Uruguay Uzbekistan Vanuatu Vatican Venezuela Vietnam Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Phone number E-mail address Date of birth Place of birth Country of origin Gender Male Female Prefer not to say Marital status Married Registered partnership Divorced Unmarried Single Number of children living at home under the age of 18 None 1 2 3 or more INCOME DETAILS Applicant 1 Are you employed or self-employed? Employed Self-employed Employment details Employer Job title Type of contract Fixed-term Permanent (or: Indefinite-term) Part-time Zero-hours contract Other I am entering my income details in the currency: USD XCG EUR Income: Gross annual salary Pension prospects Business details Type of business entity Sole proprietorship Private limited company General partnership Limited partnership with shares Other Business results for the past 3 years I am reporting my business results in the currency: USD XCG EUR Revenue Year 1 Net profit Year 1 Revenue Year 2 Net profit Year 2 Revenue Year 3 Net profit Year 3 Are you submitting this application together with a partner? Yes No GENERAL INFORMATION Applicant 2 First name Middle name (if applicable) Last name Address Street name and house number City / Place of residence Zip code County Select your country Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belau Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Saint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Cook Islands Costa Rica Croatia Cuba Curaçao Cyprus Czech Republic Democratic Republic of the Congo (Kinshasa) Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Ivory Coast Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao S.A.R., China Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palestinian Territory Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Republic of the Congo (Brazzaville) Reunion Romania Russia Rwanda Saint Barthélemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin (Dutch part) Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia/Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom (UK) United States (US) United States (US) Minor Outlying Islands United States (US) Virgin Islands Uruguay Uzbekistan Vanuatu Vatican Venezuela Vietnam Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe E-mail address Phone number Date of birth Place of birth Country of origin Gender Male Female Prefer not to say Marital status Married Registered partnership Divorced Unmarried Single Number of children living at home under the age of 18 None 1 2 3 or more INCOME DETAILS Applicant 2 Are you employed or self-employed? Employed self-employed Employment details Employer Job title Type of contract Fixed-term Permanent (or: Indefinite-term) Part-time Zero-hours contract Other I am entering my income details in the currency: USD XCG EUR Income: Gross annual salary Pension prospects Business details Type of business entity Sole proprietorship Private limited company General partnership Limited partnership with shares Other I am reporting my business results in the currency: USD XCG EUR Business results for the past 3 years Revenue Year 1 Net profit Year 1 Revenue Year 2 Net profit Year 2 Revenue Year 3 Net profit Year 3 Current financial situation Current living situation Owner-occupied home Rental property Living with parents / Living at home I am entering my current financial details in the currency: USD XCG EUR Monthly housing expenses Savings Outstanding loan balance Monthly loan repayments Do you have a negative credit registration? Yes No Unknown Purchase details Type of property Plot of land Newly built home Existing home Adres aankoop object I am entering the purchase details in the currency: USD XCG EUR Purchase price Market value of the existing home Is there a recent appraisal? Yes No Refinancing Are you planning to refinance? Yes No If refinancing the mortgage: Address? I am entering the refinancing details in the currency: USD XCG EUR Market value of the property when refinancing? If refinancing the mortgage: Outstanding mortgage balance? % If refinancing the mortgage: Monthly mortgage payment? % If refinancing the mortgage: Mortgage interest rate? % If refinancing the mortgage: Life insurance premium? If refinancing the mortgage: Home insurance premium? If refinancing the mortgage: Accident insurance premium? Additional information Declaration I hereby declare that I have completed the above truthfully! Send form
