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Loan Application Form : In completing and sending this application form to Clearway Finance, you are under no obligation to proceed with the application. The purpose is to enable us to provide a confidential quotation and acceptance.

Please complete each section as requested and submit the form. Written details will be posted to you within 24 hours of receipt of the form. * These fields all require completion for us to respond, including a valid email address.

(*) Name Of Applicant (A)

Name Of Applicant (B)

(*) Address

(*) Town

(*) County

(*) Postcode

(*) Home Telephone

Work Telephone

Mobile Telephone

(*) E-mail Address

(*) Date Of Birth (A)

Date Of Birth (B)

(*) Annual Income (A)

Annual Income (B)

(*) Time In Job (A)

Time In Job (B)

(*) Date Purchased

(*) Purchase Price Of Property

(*) Current Value Of Property

(*) Mortgage Outstanding

(*) Monthly Mortgage Payment

(*) Mortgage Lender

(*) Current Mortgage Arrears

(type none if n/a)

(*) Highest Arrears In Last 12 Months

(type none if n/a)

(*) Loan Amount Required

(*) Purpose Of Loan

(*) Repayment Period (months)

(*) Payment Protection Required?

(*) How Should We Contact You?

(*) How Did You Find Our Website?

Your home may be repossessed if you do not keep up repayments
on a mortgage or other debt secured on it

I / we agree the information given may be used to get credit reference searches which will be recorded and disclosed on any other credit search. I / we agree you or any lender you submit this application to may ask any third party to verify the information. I / we agree this information and the details and conduct of any loan I / we obtain, may be recorded in any reference agency and updated and used by any lender and others in making credit decisions about me / us and other members of my / our household, tracing debtors and controlling fraud. I / we agree lenders may release information to their own funders or insurers and advisers. I / we agree the information may be used to offer products which you, or any other company you have given it to believe may interest me / us unless I / we tell you or any relevant company not to in writing.

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I / we confirm that the information contained and supplied
herewith by me / us is correct to the best of my / our belief.

Clearway Finance (UK) Ltd is a registered member of The Association Of Finance Brokers (AFB).

Clearway Finance (UK) Ltd is authorised and regulated by The Financial Services Authority. Our register number is 312571,

Clearway Finance (UK) Ltd is a registered member of The Finance Industry Standards Association (FISA)

Your home may be repossessed if you do not keep up
repayments on a mortgage or other debt secured on it

Fresh Start Funding : Freshstartfunding.co.uk - Clearway Finance : Clearwayfinance.co.uk - Leven Finance : Levenfinance.co.uk

Clearway Finance (UK) Ltd, Tirrem House, 16 High Street, Yarm, Cleveland, TS15 9AE

Free Phone : 0800 096 0321, Facsimile : 01642 801711