Are you directly authorised by the Financial Conduct Authority:

Yes

No

Are you an appointed representative of a network who is authorised by the FCA: *

Yes

No

Have you charged the customer any other fees in connection with this transaction?:

Yes

No

Are the fees payable up front OR at commencement of the mortgage:

Up Front

Combination of Fees

At Commencement

Are any of the fees you charge the customer or the procuration fee you may receive from the Furness Building Society being refunded or rebated to the customer, in any circumstances e.g. if the application does not proceed?

Yes

No

Do any of the fees change if the amount of the mortgage changes?

Yes

No

Are any of the fees you charge the customer or procuration fee you may receive from Furness Building Society being paid to another 3rd party e.g., Network, Mortgage Club or another individual apart from the customer themselves:

Yes

No

Type of mortgage

Single

Joint

Purchase Type

Remortgage

Purchase

Further Advance

Is this a Shared Ownership purchase?

No

Yes

Repayment Type:

Interest Only

Repayment

ISA

Part & Part

How should the application fee be paid?

Add to mortgage balance

Payment made up front

N/A

How should the completion fee be paid?

Add to mortgage balance

Payment made up front

N/A

How should the CHAPs fee be paid?

Add to mortgage balance

Payment made up front

N/A