THIS FORM IS FOR INTERMEDIARIES INTERNAL USE ONLY AND IS NOT APPROVED FOR ISSUING TO CUSTOMERS.

DATA CAPTURE FORM Customer Name(s) 1. 2. THIS FORM IS FOR INTERMEDIARIES INTERNAL USE ONLY AND IS NOT APPROVED FOR ISSUING TO CUSTOMERS. The form is to be used to capture information for a Secure Trust Bank mortgage when access to the online system is unavailable. This form is NOT to be submitted to Secure Trust Bank. It will not be actioned and will be returned to you for electronic submission. Ensure this form is completed accurately and in full to ensure successful application submission for Decision in Principle and Full Mortgage Application. 1

INTERMEDIARY DETAILS INTERMEDIARY DETAILS Mortgage Club/ Packager Name Principal FCA No Company Name Introducing Adviser s Name FCA No Company Address Contact Phone No E-mail Address Are You: Appointed Representative Directly Authorised PRE-REQUISITE QUESTIONS PRE-REQUISITE QUESTIONS 1. Has any applicant had a Pay Day loan in the last 12 months? Yes No 2. Has any applicant been subject to a Bankruptcy order, Bankruptcy restriction order or IVA within the last 36 months? Yes No 3. Has any applicant been subject to a Debt Management Plan in the last 24 months? Yes No 4. Are all applicant(s) paid in UK Sterling and will the loan will be paid from a UK Bank Account? Yes No 5. Will the property be used for any commercial purpose? Yes No 6. Does any applicant have diplomatic immunity in the UK? Yes No 7. Is the property a flat with shared deck access? Yes No 8. Are you acting on behalf of the applicant under a Power of Attorney? Yes No NB. If any answer above in the blue box is ticked, please call us on 0330 303 3495 to discuss your case before proceeding. 2

LOAN DETAILS HOW WAS THE SALE MADE? Non - Advised Advised Sale Face To Face Telephone Internet Post LOAN DETAILS Purpose Purchase Remortgage Loan Type Residential First Time Buyer? Yes No Right To Buy? Yes No Product Proposition Estimated value / Purchase Price (whichever lower) Is the property being purchased from a member of an applicant s family? Min Loan size for Larger Loans is 500,000 Larger Loans Only STB Only Larger Loans and STB Yes No Discounted Purchase Price (If applicable) Open Market Value Loan Amount Loan Term years months Anticipated Monthly Rental Income (Let To Buy only) Capital and Repayment Interest Only Part and Part Repayment Amount: Repayment Type. Interest Only Amount: Gross Value.. Max 65% interest only Monthly Amount (Only required for Endowment and Pensions) Sales of Property Repayment Strategy (Interest Only Part) Sales of Other Property Endowment If Repayment Type is Shares, please provide the Company name and the Maturity date Shares e.g. Investment Portfolio Savings e.g. Cash & Term Deposit Pensions Arrangement Other Repaymant Vehicle Company Name: Maturity Date:. 3

LOAN DETAILS LOAN DETAILS Source of Deposit Please confirm donor name and address on the Additional Information pages Saving / Inheritance Sale of own property Gifted Deposit from Close Relative Gifted Deposit from Builder (max 5%) Gifted Deposit from Vender Amount Will this be the main residence for all applicants? If No, please provide an explanation: Yes No Explanation:.. Tick this box if information has been provided on the Additional Information pages. USE OF FUNDS Remortgage Only Please indicate how the loan amount will be all allocated below Use of Funds Amount Use of Funds Amount Use of Funds Amount Tick this box if information has been provided on the Additional Information pages. 4

APPLICANT(S) DETAILS APPLICANT(S) DETAILS Title First Name Middle Name Surname Date of Birth Estimated Retirement Age Nationality Country of Birth Permanent Right to reside in the UK Length of Residency Years Months From Birth Years Months From Birth Diplomatic Immunity Marital Status Single Living with Partner Married / Civil Partnership Divoced/ Annulled Civil Partnership Single Living with Partner Married / Civil Partnership Divoced/ Annulled Civil Partnership Has either Applicant been known by another name in the last 6 years? Title First Name Middle Name Surname 5

APPLICANT(S) DETAILS CURRENT ADDRESS Is it a non-uk address? Full Address Time at current address / To / / To / Residential Status Home telephone number Work telephone number Mobile number E-mail Address Preferred Contact Number National Insurance Number Owner with Mortgage Owner without Mortgage Joint Mortgage Holder Shared Ownership Renting Private Landlord Renting Housing Association /Local Authority Renting Corporate Letting Agent Living with Relatives / Friends Owner with Mortgage Owner without Mortgage Joint Mortgage Holder Shared Ownership Renting Private Landlord Renting Housing Association /Local Authority Renting Corporate Letting Agent Living with Relatives / Friends PREVIOUS ADDRESS Is it a non-uk address? Full Address Time at address / To / / To / Residential Status 3 years address history required. Tick this box if information has been provided on the Additional Information pages. 6

PRIMARY EMPLOYMENT DETAILS EMPLOYMENT DETAILS Employment Status Employed Self-Employed Fixed Term Contract Retired Unemployed Homemaker Other Employed Self-Employed Fixed Term Contract Retired Unemployed Homemaker Other More than 25% shareholder in the company? If an applicant owns more than 25% of the company, they will be treated as self-employed. Please complete the self-employed section. FOR EMPLOYED AND FIXED TERM CONTRACT ONLY Full Time Occupation Employed Since month year month year Has contract previously been renewed? (If contracting) Will contract be renewed or has an alternative contract been secured? (If contracting) Company Name Yes No N/A Yes No N/A Yes No N/A Yes No N/A Company Address Company Phone Number Still within probation Yes No If yes, end date of probation Yes No If yes, end date of probation Basic salary Basic salary Overtime Overtime Salary Commission Commission Bonus Bonus Allowance Allowance Employed by a family member 7

PRIMARY EMPLOYMENT DETAILS FOR SELF EMPLOYED & CONTRACTORS Full Time Occupation Date commenced trading Company Name Company Address Company Phone Number Please provide your confirmed income for at least 1 year. If previous years confirmed income is available, this should be provided. Percentage of business owned Applicant s Earned income (most recent first) % % Year 1 Year ending Year 1 Year ending Year 2 Year ending Year 2 Year ending Year 3 Year ending Year 3 Year ending Accountant Company Name Accountant Contact Name Qualifications How long have accountants acted for the applicant? years months years months Accountant s Address 8

SECONDARY EMPLOYMENT DETAILS SECONDARY INCOME Employment status Full Time Employed Self-Employed Fixed Term Contract Employed Self-Employed Fixed Term Contract Occupation Since FOR EMPLOYED AND FIXED TERM CONTRACT ONLY Has contract previously been renewed? (If contracting) Will contract be renewed or has an alternative contract been secured? (If contracting) Yes No N/A Yes No N/A Yes No N/A Yes No N/A Company Name Company Address Company Phone Number Still within probation Yes No If yes, end date of probation Yes No If yes, end date of probation Basic salary Basic salary Overtime Overtime Salary Commission Commission Bonus Bonus Allowance Allowance Employed by a family member 9

SECONDARY EMPLOYMENT DETAILS FOR SELF EMPLOYED AND CONTRACTORS Date commenced trading Company Name Company Address Company Phone Number Please provide your confirmed income for at least 1 year. If previous years confirmed income is available, this should be provided. Percentage of business owned % % Year 1 Year ending Year 1 Year ending Applicant s net profit (most recent first) Year 2 Year ending Year 2 Year ending Year 3 Year ending Year 3 Year ending Accountant Company Name Accountant Contact Name Qualifications How long have accountants acted for the applicant? years months years months Accountant Address 10

OTHER SOURCES OF INCOME OTHER SOURCES OF INCOME Other Sources of income Please complete this section if you receive other sources of income. E.g. Pension, Disability Living Allowance, other State Benefits, Maintenance/ CSA payments/alimony or other. Tick this box if information has been provided on the Additional Information pages. FOR ALL INCOME FOR ALL INCOME Does the applicant foresee any changes in the level of their income or expenditure which may affect their ability to meet the mortgage payments? Please provide details 11

COMMITMENTS CURRENT MORTGAGE COMMITMENTS Owner occupied only Existing residential mortgage to be redeemed on completion? Reason for not redeeming on completion? Plan to let current property Family will remain in property Other Plan to let current property Family will remain in property Other Monthly residential mortgage payment Residential mortgage balance outstanding Estimated value of current residential property Name of Lender Account number RENTAL COMMITMENTS Renting only Monthly residential rental repayment Name of Landlord Landlord address COMMITMENTS Type of Commitment App 1 App 2 Joint End Date Name of lender/ Company Monthly repayment Balance outstanding To be repaid at completion Account No (last 4 digits) if secured Y/N Y/N Y/N Y/N Y/N Y/N Y/N Y/N Tick this box if information has been provided on the Additional Information pages. 12

COMMITMENTS CONT. OTHER COMMITMENTS Type of Commitment App 1 / App 2 / Joint Monthly repayment End Date Maintenance/ CSA payments/ Alimony Bank Overdraft School Fees Pension Contribution Student Loan Other e.g. Mail order Tick this box if information has been provided on the Additional Information pages. BTL PORFOLIO Does the applicant own any investment / buy-to-let properties? Total number of properties? Estimated value of portfolio? Total outstanding balance of mortgages? Total monthly portfolio rental income? Total monthly portfolio mortgage payments? 13

ADVERSE DETAILS ARREARS Has the applicant(s) had a missed or late payment in the last 36 months? Commitment Type if secured Max arrears Status in the last 12 months Max arrears Status in the last 13-24 months Max arrears Status in the last 25-36 months App1 App2 Joint DEFAULTS Has the applicant ever had a default registered against them? Date registered Amount Date of satisfaction Date registered Amount Date of satisfaction Tick this box if information has been provided on the Additional Information pages. COUNTY COURT JUDGEMENTS Has the applicant ever had a County Court Judgment registered against them? Date registered Amount Date of satisfaction Date registered Amount Date of satisfaction Tick this box if information has been provided on the Additional Information pages. INDIVIDUAL VOLUNTARY ARRANGEMENTS, DEBT MANAGEMENT PROGRAM OR PROTECTED TRUST DEED Has the applicant ever been subject to an Individual Voluntary Arrangement, Debt Management Program, Debt Relief Order or Protected Trust Deed? Type Date registered Date of satisfied Type Date registered Date of satisfied Tick this box if information has been provided on the Additional Information pages. 14

ADVERSE DETAILS CONT. BANKRUPTCIES Has the applicant ever been made bankrupt? Date of Bankruptcy order Date Bankruptcy discharged Date of Bankruptcy order Date Bankruptcy discharged Tick this box if information has been provided on the Additional Information pages. REPOSSESSION Has the applicant ever had a property repossessed or surrendered? Date of repossession/ surrender Date of repossession/ surrender Tick this box if information has been provided on the Additional Information pages. HOUSEHOLD EXPENDITURE HOUSEHOLD EXPENDITURE Please complete the following fields to confirm the applicant s current expenditure against each of the provided categories:- Council Tax Childcare (if applicable) Building and Contacts Insurance Ground Rent & Service Charge Other Household Expenditure Please complete under Applicant 1 section if this is for Joint application. DEPENDENTS Number of non-applicant adult dependents No of child dependents 15

PROPERTY DETAILS DETAILS OF PROPERTY TO BE MORTGAGED Full Address PROPERTY Property description House Flat/Maisonette Studio Flat Bungalow Coach House Flat/Maisonette above commercial Detched Semi- Detached Mid - Terrace Property Type End-Terrace Conversion Cluster/Back-To- Back Purpose Built Purpose Built Flat Converted Flat Is Property a New Build? Yes No Year of construction (yyyy) NHBC Premier Guarantee Build Zone Certificate type (if built or converted within the last 10 years) LABC New Home Warranty Build Assure (New Homes Structural Defects Ins.) Checkmate/ Castle 10 Home Guard Zurich BLP (Building Life Plans) excel. Self build under construction Construction Register Limited Other Number of Storeys in Building Floor on which flat is situated Does building have a lift? Yes No Remaining Lease Term (Min.85 years at end of term) Standard Construction Brick Stone Block Block with inner walls of brick Non traditional construction Wall Construction type Timber frame with OuterWalls of Brick/ Stone/ Block built 1970s or after Modern methods construction (MMC) incl. panelised, volumetric, hybrid Timber frame built prior to 1970 Timber frame without brick, stone or block outer wall Steel framed Single brick walls Other Roof Construction Type Number of bedrooms Pitched, Timber framework and clad in slate or tiles Fully flat roof on a main house structure Number of kitchens Number of bathrooms Thatched Other. 16

PROPERTY DETAILS CONT. PROPERTY Type of Sale Private Sale Via Estate Agent Purchase from Landlord as tenant Purchase from Builder Purchase from Relative Shared Ownership Shared Ownership Final share purchase Tenure Freehold Leasehold True Freehold Flying Freehold Commonhold Ground rent Service charge Is the property connected to or above a commercial property? Yes No Is any of the property to be used for commercial purposes? Yes No Was the property originally purchased from the local authority? Yes No If yes, please provide details If yes, what is the type of business If yes, what was the purchase date Are there any Occupancy Restrictions applicable to the property? Yes No VALUATION TYPE Valuation Type Mortgage Valuation Mortgage Valuation and Homebuyers Report Mortgage Valuation and Building Survey ARRANGEMENTS TO ACCESS PROPERTY Contact Contact Name Applicant Builder Vendor Agent Other Contact Telephone Number Please provide any additional information which will help the valuer to gain access OTHER OCCUPANTS Upon completion, will there be any other occupants living at the property who are aged 17 or over? Yes No First name Surname Date of Birth Relationship Tick this box if information has been provided on the Additional Information pages. 17

PRODUCTS AND FEES PRODUCT REQUIRED Product Name Max LTV Product Fee LENDERS FEES Fees Amount Add to Loan Funds Release Fee Product Fee Add to loan Deduct from loan Add to loan Deduct from loan Mortgage Exit Fee 30 INTERMEDIARY AND PACKAGER FEES Are there any intermediary or packager fees being charged to the applicant? Yes No Intermediary or Packager Amount When payable (Application / Offer / Completion) Refundable amount 18

SOLICITOR DETAILS When selecting a solicitor as part of an application submission you will be presented with two options. You can select an existing panel solicitor, or enter the details of a solicitor firm that wishes to be added to our panel, or enter a solicitor to act for you on a separate representation basis. Our preferred solicitor for purchase applications is Lightfoots LLP who can act under joint representation on behalf of your applicant and the bank. We work closely with them and they offer fixed fees for a standard purchase. The applicant(s) can also choose from a list of approved firms, who can act under joint representation on behalf of your applicant and the bank; these can be viewed at www.securetrustbank.com/intermediaires or contact the Intermediary Support Team on 0330 303 3495 for further information. If the applicant s solicitor is not approved for the panel we will contact you to offer the following options: a) Postpone issuing the offer until the submitted solicitor is added to the panel. b) Select another solicitor already on the panel to act on behalf of the applicant(s) and the bank under joint representation. c) If the applicant(s) still want to use their preferred solicitor they can continue under separate representation with Lightfoots LLP acting on behalf of the bank. Under separate representation, the chosen solicitor will act on the applicant s behalf whilst Lightfoots LLP act on the bank s behalf. This may lead to longer than usual processing times, and the applicant(s) are responsible for both sets of legal fees. Please view the Intermediary Guide to Solicitor Selection for more information. You can view the guide here: www.securetrustbank.com/intermediaires Optima Legal must be selected for all re-mortgages. Optima Legal will act on behalf of the bank only and will not provide your applicant with any legal representation. If the applicants would like their own representation, they can seek independent legal advice via an alternative solicitor at their own cost. APPLICANT S SOLICITOR DETAILS Solicitor Contact Name Firm Name Company Address Telephone number Email address Fax number DX number When a panel solicitor is instructed, they will act on behalf of both the applicants(s) and Secure Trust Bank. For this reason, Secure Trust Bank has an approved panel of solicitors to act on behalf of the applicant(s). If a solicitor or licensed conveyancer who isn't on our panel is instructed by the applicant(s), Secure Trust Bank will also instruct its own solicitor. This will mean that the applicant(s) will be responsible for Secure Trust Banks legal fees in addition to their own and longer mortgage application processing times may be experienced. For more information regarding fees applicable, applicant(s) are advised to contact their solicitor. For further information on the fees payable to Secure Trust Bank's solicitor, please view the Intermediary Guide to Solicitor Selection. You can view the guide here: www.securetrustbank.com/intermediaires or alternatively you can contact the Intermediary Support Team on 0330 303 3495. Please indicate by signing the box below, that the applicant(s) has been fully informed and fully understand the implications of selecting a solicitor which is not a member of Secure Trust Bank's panel. Adviser Name: Signature: Date: 19

DIRECT DEBIT DETAILS DIRECT DEBIT ASSOCIATION Applicant associated with bank account BANK DETAILS Account holder name Sort code Account number Bank name Bank Address Please note this is not a Direct Debit Mandate. A separate Direct Debit mandate is required. CONVICTIONS Does the applicant have any criminal convictions other than those which are spent under the Rehabilitation of Offenders Act 1974 (or equivalent), or any pending prosecutions relating to any aspect of dishonesty, such as theft, robbery, fraud or arson; which may have a bearing on your future employment or the likely conduct of the mortgage? * Yes No If yes, please provide details of all convictions below 20

ADDITIONAL INFORMATION ADDITIONAL INFORMATION Please use the space below to detail any additional information, ensure it is clear to which section of the form it is related. 21

ADDITIONAL INFORMATION CONT. ADDITIONAL INFORMATION CONTINUED Please use the space below to detail any additional information, ensure it is clear to which section of the form it is related. 22

SE ADVISER DECLARATIONS USE OF PERSONAL DATA The following must be read by you to the applicant(s). "Full details of how your data will be used are detailed in the Mortgage Application Declaration which will be provided to you. Secure Trust Bank will keep your information confidential and use this to manage accounts and, if requested, keep you informed of products and services that may be of interest. They will share your information: With credit reference and fraud prevention agencies and other organisations who may record, use and give out information to other lenders and insurers. The information may be used to make assessments for credit and all types of insurance, for debt tracing, to verify identity and to prevent fraud and money laundering. With persons acting as our agents under a strict code of confidentiality. With anyone to whom they transfer or may transfer their rights under any agreement with them. As required by law or regulation. At this stage of the application, Secure Trust Bank would like to do a credit search. Please note that false or inaccurate information will be shared with credit reference and fraud prevention agencies. Legally the applicant s permission is required to do a credit search, and the permission of anyone with whom they have a financial link. If the applicant(s) does not have a financial link with anyone, then it is only the applicant s permission that is required. If the Data Capture form is used to obtain a Decision In Principle, the search will only leave a 'soft footprint. This will only become a hard foot print when a full mortgage application is submitted. Any 'association' with a joint applicant will be linked at the credit reference agencies and may be taken into account in future credit applications. Please confirm by completing the box below that you have explained the full implications of this to the applicant(s) and obtained the applicant s permission to carry out the credit check. Adviser Name: Signature: Date: INTERMEDIARY DECLARATION I confirm that I have been authorised by all applicant(s) to complete this application on their behalf. I confirm that all information entered is true to the best of my knowledge. I confirm I have personally provided advice to the applicant(s). Adviser Name: Signature: Date: DIRECT DEBIT DECLARATION The Applicant(s) have been advised and accept that the details input on the direct debit mandate form will be used to set up the direct debit on the completed mortgage account and the account is in the name of the applicant(s). These payment details cannot be changed until the first full monthly payment has been collected. Adviser Name: Signature: Date: 23

ADVISER DECLARATIONS FMA DECLARATION By choosing to proceed to a full mortgage application, Secure Trust Bank plc will place an electronic footprint on the credit file of each mortgage applicant because you are seeking a commitment from Secure Trust Bank plc to lend. Information will also be shared with fraud reference agencies and may be shared with HM Revenue and Customs. I confirm that I have verified the applicant(s) identity in accordance with all applicable legal and regulatory standards. Adviser Name: Signature: Date: MARKETING CONSENT MARKETING CONSENT Secure Trust Bank and its group of companies would like to keep your client informed of products, services, and member offers that we consider relevant to them. We will not share their information with external companies for the purposes of marketing. If your client does not wish to be contacted by a particular method, please check 'No' in the boxes below: Please contact me by telephone Please contact me by letter Please contact me by SMS Please contact me by email Yes Yes Yes Yes No No No No CHECKLIST Have all the relevant sections been completed? Have the Adviser signed all the Declarations? Has the correct product been clearly identified? When input at FMA, please note 1) Employment company address details are under the employment section 2) Accountant details are in the Self-employment section For more information, call 0330 303 3495 or visit https://www.securetrustbank.com/mortgages-by-secure-trust-bank 24