Loan Application Form

Welcome to the Anglian/Safestyle/Everest (ASHI Group) Backup Loan Submission Form

Please complete the below application form with your customer and once submitted, the application will be processed ASAP and you will be notified of the outcome. Once Stax is back online, your dashboard will update accordingly.

Your Details (Staff Member)

Your Full Name *

Branch *

Email Address *

Contact Number *

CLICK TO SELECT THE PRODUCT

Total cost of purchase (£) *

Finance Product *

Interest Bearing

Please select APR *

Please select Term *

Deposit Amount *(£0 TO £0)

Deposit Percentage *(0% TO 50%)

Loan Amount£0.00

Monthly Payment£0.00

Total Repayable£0.00

PERSONAL DETAILS

Title *

First Name *

Last Name *

Date of Birth *

Marital Status *

Country of Birth *

Nationality *

Gender *

Email Address *

Confirm Email Address *

UK Mobile Phone *

UK Home Phone

UK Work Phone

ADDRESS DETAILS

Occupancy Status *

Installation Address

Are the goods being installed at the current address?Yes

Current Address

Address Line 1 *

Address Line 2

City *

County

Postcode *

Years at Address

0 Years

Months at Address

0 Months

Previous Addresses

As you have lived at your current address for less than 3 years, please provide your previous address history.

No previous addresses added yet.

Total address history: 0 years, 0 months(Need 36 more months of address history)

EMPLOYMENT DETAILS

Employment Type *

Current Job Start Date *

Name of Employer *

Contract Type *

Are you a Statutory Director or Board Member? *

Employment Sector?

Employer Country

Job Title *

FINANCIAL DETAILS

INCOME

Gross Annual Personal Income (£) *

Total Household Income (£) *

Net Monthly Personal Income (£) *

EXPENDITURE

Number of dependants *

Contribution to Rent or Mortgage (Monthly) (£)

Other Expenses *

YesNo

BANK DETAILS

Account Holder Name *

Account Number *

Sort Code *

Years at Bank

By completing your bank details, you are confirming that you are an account holder on the specified UK Bank/Building Society Account and that you are the only person required to authorise debits from this account, which is registered to your home address. Our lender's Direct Debit Guarantees can be found here.

DISCLOSURES & CONSENT

The lender may share information about you and your financial associates with credit reference agencies (CRAs) and fraud prevention agencies. Your application for credit will be sent to the lender who will search with CRAs and fraud prevention agencies to check that there's no record of fraud or stolen identity. In the event you are successful, the lender may share information with CRAs about your credit agreement and how you manage it. In the event of an unsuccessful application a 'decline' may carry out a 'further search' and brief searches may leave a footprint on your credit file.

CRAs will keep a record of any searches or information shared with them. This information may be shared with other lenders, and other organisations that may use the information to make decisions.

The personal information the lenders have collected from you will be shared with fraud prevention agencies who'll use it to prevent fraud and money laundering and to verify your identity. Further information for how your information may be used by us and these third party lenders can be found in our privacy notice. Credit reference and fraud prevention agencies and their data protection rights, can be found at www.cifas.org.uk.

You can find out more about CRAs and how they use your information at Credit Reference Agency Information Notice (CRAIN) - Equifax / Experian / Credit Karma.

You can find out further information in the panel of Lender's Data Protection Notice or Data Protection notice.

By continuing with this application, you are agreeing the personal data provided, (including sensitive data where relevant), will be processed to access credit and shared with our lender(s) as detailed in our privacy notice highlighted above. In the event you are unsuccessful, your application will be automatically re-submitted to our panel of lenders as our payer, if another lender is available.

* I confirm I understand the above statement

* By continuing with this application, the data provided will be processed to access credit and shared with our lender. In the event you are unsuccessful, your application will be automatically passed to the next available lender across our panel. If this happens you may be offered a different finance product to the one you originally applied for. You have no capability issues that could affect managing this loan. This includes anything that might influence your future financial stability or ability to repay this loan.

* Please confirm that the information you have provided is accurate and up to date, and that you can afford the credit repayments over the term of the agreement. This should take into account any known or expected change in financial circumstances, such as working fewer hours, going on maternity leave or any increase in your mortgage or rent repayments.