Finance Application

1 Personal Details

Title

Date of Birth

First Name(s)

Surname

Email Address

Mobile / Phone

Nationality

2 Current Address

Address Line 1

Address Line 2

Town / City

County

Postcode

Time at Current Address

Residential Status

Previous Address (if at current address less than 3 years)

Previous Address

Time at Previous Address

3 Employment Details

Employment Status

Employer / Company Name

Job Title / Occupation

Time with Current Employer

Annual Gross Income (£)

Employer Address

Address Line 1

Address Line 2

Town / City

County

Postcode

4 References

Please provide two references. At least one should be a friend or family member residing at a different address to the applicant.

Reference 1

Full Name

Relationship to Applicant

Address (must differ from applicant's address)

Phone Number

Email Address

Reference 2

Full Name

Relationship to Applicant

Address (must differ from applicant's address)

Phone Number

Email Address

5 County Court Judgements (CCJs)

A County Court Judgement (CCJ) is a court order registered against an individual for an unpaid debt. You must declare any CCJ recorded against yourself or any other person residing at your address. Failure to disclose this information may result in your application being declined.

Does anyone at the applicant's address have a CCJ recorded against them?

No Yes

If yes, please provide details

6 Supporting Documents Required

The following documents must accompany your completed application form. Please ensure all documents are clear, legible, and valid. Photocopies and scanned copies are acceptable.

🪪

Photographic ID

Valid passport or UK driving licence. Must show your full name and photograph clearly.

🏦

Bank Statement

Most recent statement dated within the last 3 months. Must show your name and account details.

🏠

Utility Bill

Gas, electricity, water, or broadband bill dated within the last 3 months, showing your name and current address.

⚠️ Applications received without the required supporting documents cannot be processed. Please check all items are included before returning this form.

Checklist — please tick to confirm each item is enclosed

Completed & signed application form Photographic ID (passport or driving licence) Bank statement (within last 3 months) Utility bill (within last 3 months)

7 Declaration & Signature

I/We declare that: the information given in this application is true, complete, and accurate to the best of my/our knowledge and belief. I/We authorise Pounds (A&W Pounds Limited) to make such enquiries and to approach such sources as may be necessary to verify the information provided. I/We understand that providing false or misleading information may result in the application being refused or any subsequent agreement being terminated. I/We confirm I/we have read and understood the information provided regarding FCA regulation and CCTA membership.

Applicant Signature

Date