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Prepaid Card Introduction Form
PERSONAL DETAILS:
Compulsory Questions Marked With *
Applicant 1
Single
Living Together
Married
Seperated
Divorced
Widowed
*
Full Name
*
Data of Birth
*
Present Address
*
Post Code
*
How Long at Address
*
Years / Months
If under 3 years at present address, please give full details of previous address
Previous Address
Previous Post Code
How Long at Previous Address
Years / Months
Home Telephone
*
Mobile Telephone
Work Telephone
*
Your Email
*
Default Email Address
info@financetracker.net
Add to Mailing List
Yes
Your Nationality
UK
EU
Commonwealth
Asylum Seeker
Other
*
Are You On The Electoral Role
Yes
No
*
Prepaid MasterCard:
Prepaid Card Introduction £19.95
*
BarclayCard Transaction ID:
If you paid by debit/credit card then enter the BarclayCard reference
EMPLOYMENT
DETAILS:
Applicant 1
Are you Employed or Self Employed
Employed
Self Employed
*
How Long For
*
Years / Months
What is your Occupation
*
How Much do you Earn
GROSS P/A £
*
Can you Prove this Income
No
Yes
*
( pay-slips / P60 / Certified or Chartered Accounts
Have you received Benefits in last 12 months
No
Yes
*
( Includes Housing Benefit or DSS Assistance
ADVERSE CREDIT DETAILS:
PLEASE LIST ANY DEFAULTS / CCJ's / RENT~MORT. ARREARS / IVA's / BANKRUPTCY's BELOW
Type
Date
Registered
Amount £
Paid Y / N
If Paid,
Date Sat.
Satisfaction
Certificate
Lender
Explanation
CCJ
ARREAR
IVA
BKRCY
DEFAULT
DISCH BKRCY
Yes
No
DEFAULT
CCJ
ARREAR
IVA
BKRCY
DISCH BKRCY
Yes
No
DEFAULT
CCJ
ARREAR
IVA
BKRCY
DISCH BKRCY
Yes
No
PERSONAL DOCUMENTS:
PLEASE SELECT WHICH DOCUMENTS YOU HAVE OR CAN GET
Passport
EU ID Card
Benefits Book
Armed Forces ID Card
UK PhotoCard Driving Licence (full or prov.)
Police Warrant ID Card
Construction Industry Photo Registration Card
P60
P45
Residency Permit from Home Office to EU Nationals
NHS Card
Inland Revenue Tax Notification
Bank or Building Society Statement
Utility Bill
Council Tax Bill
Mortgage Statement
TV Licence Bill
Council or Housing Association Rent Bill
Council or Housing Association Tenancy Agreement
Private Sector Tenancy Agreement
Insurance Documentation
Letter from Solicitor
Letter from Doctor
Letter from Dentist
Letter from Ministry of Religion
Letter from Educational Institution
Letter from Employer or Job Agency
Letter from Social Worker or Hostel Manager
Application Registration Card (ARC) Issues by Home Office to Asylum Seekers
DECLARATION:
To enable us to help find a suitable Prepaid MasterCard for your financial enquiry, it is necessary to have your permission to forward your submitted details to a third party. This is an advisory service and Introduction to a Prepaid MasterCard Company. The fee of £19.95 is guaranteed to be refunded in full if you cannot obtain a Prepaid MasterCard through our guidance.
DO YOU AGREE TO THESE TERMS (Y/N) :-
Yes
( COMPULSORY )
IF YOU DO NOT AGREE TO THE ABOVE THEN PLEASE DO NOT SUBMIT THIS FORM