Applicant & Project
Name of Project
Name of Applicant or Company
Broker Details
Contact Name
Company Name
Address
Postcode
Email Address
Telephone Number
Registered Address
Unit/Building Number
Unit/Building Name
Street Address
Country
Position
Mobile Number
Fax Number
Project Address
Loan/Investment Required & Security Available
Loan Required
Loan/Investment Duration
Deposit Amount Available from the Applicant
Type of Guarantee of Security Available
Description of Applicant's Current Free Available Assets
Estimated Market Value of Applicant’s Current Free Assets
Applicant Co’s Share Capital
Total Project Cost
Shareholder's Details
Director's Details
Applicant Company History
Applicants Company’s Registration Number
Is The Applicant Already Trading?
Project /Loan/Investment Description
Project Name
Project Type
Project Consists Of
Location
Amount Seeking
Developer
Time Frame
Entitlements
Appraised Value as is
Appraised Value as Completed
Total Cash Invested
Total Current Equity & Assets
Total Debt
Loan to Cost
Status
Exit Strategy
Project Costs
Proposed Project Funding
Employees
Number of Current Employees at the Project Location?
Planning
Is Planning Permission Required?
If Yes Who is the Planning Authority?
Date Applied For
Date Approved
Land/Premises Freehold Leasehold Other
If leasehold, date of termination of the lease
What is the size of the existing site and buildings?
Site in Hectares
Building in Sq. Metres
What is the Proposed Project Site/Building Size?
Site in Hectares?
Project Schedule
Proposed Project Start Date
Completion Date
Required Funding Schedule (amount required during)
Financial Information
Applicants Company's Asset Value
Fixed Assets (market value)
Current Assets
Current Liabilities
TOTAL ASSETS
Long Term Liabilities
TOTAL LIABILITIES
The Company's Net Asset Value
Income Forecast From Start Date
14. Additional information that may be relevant to the application
Declaration
I/We understand that the personal information provided in this Application will be subject to the Data Protection Act 1998. To administer and service this application the Funder may search records at credit reference agencies, which may be linked to records relating to your spouse or partner or other persons with whom you are linked financially and other members of your household. For the purpose of this application you may be treated as financially linked and you will be assessed with reference to associated records. Where any search or application is completed involving joint parties, you both consent to us recording details at credit reference agencies. As a result an 'association' will be created with will link your financial record and your associate's information may be taken into account when future search is made by us or another unless your file a 'disassociation' at the credit reference agencies. Declaration I/We declare and confirm that the information contained herein and supplied by me/ us is true, accurate and complete, and can be used to form the basis of any contract between me / us and the lender. I / we agree and confirm that the lender may make such enquiries, obtain references and confirmations, as may be deemed appropriate. I / we also agree that any information obtained and held about me / us may be retained on computer and disclosed to other persons for the purposes required by the lender by submitting this by fax and electronic means. I/we (the Applicants) confirms than the lender can accept this form authorised in this way by me/us.
You must accept the declaration above to proceed with your application. I accept the Declaration above.
(Please tick the box to accept the declaration and proceed with your application.)