DIP reference number:

Surname of applicant:

Repayment status:

Was the sale conducted under a regulated environment:

Yes:    No:  

Was the mortgage sale advised:

Yes:    No:  

Is there a single premium MPPI policy included in the loan:

Yes:    No:  

Is there an Intermediary services fee:

Yes:    No:  

If yes, please give amount of fee:

Is the fee refundable:

Yes:    No:  

Is the fee included in the loan:

Yes:    No:

Is this fee payable on application or completion:

Preferred method to receive KFI:

Email:  Fax:  

Your email or fax details:

Requested by (contact name):

FSA number:

Any comments: