The
	equityRelease
		Centre

EQUITY RELEASE QUESTIONNAIRE

To help us assess how we can best help you, please complete all sections of the following form and press submit. We will then call you back as soon as possible to discuss how we may be able to help.

Alternatively should you hate filling in forms and would prefer us to ask you the questions, simply call us on 0118 958 8810.

General Details

Name (First life)	*	Name (Second life)
Date of birth (First life)	dd/mm/yyyy * Current Age Please note that all applicants must be 55 or over.	Date of birth (Second life)	dd/mm/yyyy Current Age Please note that all applicants must be 55 or over.
Marital status (First life)	*	Marital status (Second life)
Address	*
Postcode	*
Telephone Number	*
E-mail address	*

Property

Type of property	*	If a Flat how many storeys in block?
Is the property currently in joint names?	*	If no - state ownership (e.g., tenants in common)	*
Is the property	*	If leasehold - number of years left on lease (must be at least 75 years)	*
How many bedrooms does the property have?	*
Is it sheltered accommodation?	*
What are the walls made of?	*
Estimated value of property (must be worth at least £40000 or £50000 if sheltered accommodation)	£ *
Please indicate amount of any outstanding mortgage or loan secured on the property.	£ *	How many years left to repay?	years
If the amount of equity released is insufficient to repay the loan are you prepared to pay the balance?

Loan details
Please state the reason you are interested in equity release	*

Do you require a minimum amount for a specific purpose?	*	If yes - how much?	£
Do you prefer the idea of...	*	If a reversion scheme what % of your home do you want to sell?	%
Do you want Lump Sum or Income?	*


Other considerations
Have you already discussed this with your family?	*	If no, please state why
I have read your Privacy Statement and I authorise you to use this information to acknowledge receipt of my information and to communicate with me regarding my enquiry. I would like to receive other relevant information and offers from The equityRelease Centre. (If you do not want to receive other information please untick box)
How did you find us?
Which search engine/site did you come from?
What search term did you use?

By submitting this form you agree to an advisor contacting you.

Your home may be repossessed if you do not keep up repayments on your mortgage.

For researching and arranging the best Interest Only Mortgage scheme for you, we will make a charge. This can be paid by you either as a fee, usually 2.25 % of the loan payable on application to the lender, but subject to a minimum of £1350 and any commission we receive from the lender will be refunded to you, or a combination of fee and commission, so that the total remuneration received would not be less than £ 1,350 . We would retain any commission received from the lender towards this fee. Where the commission received is less than £1350 you would pay a fee for the balance on completion.

The equityRelease Centre
8a Richfield Avenue
Reading
Berkshire
RG1 8EQ
Tel: 0118 958 8810

e-mail:
enquiries@uk-equity-release-centre.co.uk

Principal:
Keith Hargraves

The equityRelease Centre is a trading style of Advice on Money which is an appointed representative of Sesame Ltd, which is authorised and regulated by the Financial Services Authority. Sesame is entered on the FSA register (www.fsa.gov.uk/register/) under reference 150427.

The information contained in this web site is for general information only and is not financial, investment or tax advice. It is also subject to the UK regulatory regime and is therefore restricted to consumers based in the UK. If you would like to discuss a particular issue or generally ask us how we can advise on your particular situation then please contact us.

For researching and arranging the best scheme for you, we will make a charge. This can be paid either by you as a fee, usually 2.5% charged on completion with any commission received from the lender refunded to you, or a combination of fee and commission, usually 1.5% fee charged on completion and 1% commission received from the provider.

Please read our Privacy Statement before sending any enquiry form or email to us.