Important Note Re Application We need to know about you and your credit history(if any). We need to know about your ability to repay. We need to know about the car you wish to buy, Step 1 of 4 - Introduction 25% Please tick the appropriate boxes* (A) I have never had a credit/repayment problem. (B) Unfortunately I had previous credit problems,now sorted - explain by email. (C)I have no credit history-this is my first finance proposal. (D) My bank statements showing my income/outgoings will demonstrate I have the ability to pay for this car finance.Email to email@example.com If you tick (b) or (c) above you must submit 3 months up to date bank statements with (name,address,account number on them) please photo/scan and email to us after you have submitted your application. I consent to my personal data being held and processed in accordance with your Data Protection Policy* I consent to my personal data being held and processed in accordance with your Data Protection Policy I consent to credit searches being undertaken on me with credit reference agencies* I appoint LCI to act as my credit intermediary to secure car finance and i consent to credit searches being undertaken on me with credit reference agencies and communication of credit decision to garage. Note (Copy bank statements for last three months show income and ability to repay and while not essential they do support your application and accelerate the credit decision.Use your phone to photo/screenshot and forward Bank Statements and or P.60/Payslip) PPS NUMBER*PROOF OF INCOME (recent payslip) & ID REQUIRED: PLEASE EMAIL TO: firstname.lastname@example.orgCUSTOMER DETAILSName(As exactly matches your bank statement)* First Last Address( As exactly matches your bank statement)*Length of time at the above address*Date of Birth*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Previous Address(if less than 3 years)Country of birth*Phone (mobile)*Email* House Ownership*OwnerTenantLiving with parentsMonthly Mortgage Payment (fill in 0 if renting)*€ Rent (per month) (fill in 0 if paying a mortgage)*€Marital Status*SingleMarriedSeparatedNumber of dependants*Please enter a value between 0 and 20.Age range dependants (eg 3 to 10)*Please enter a value between 0 and 20.*Please enter a value between 0 and 20. DETAILS OF CAR BEING PURCHASEDFor pre-qualifying please fill in details of car desired and estimated cost. More information about the benefits of pre-qualifying is available here.Make/Model / (full speck if possible)*Year of the car you are buying*Name of Dealer/Name of Contact & Phone Number*Cost of Car*€Trade in value*€Existing Finance Settlement€Deposit*€Finance Amount Required*€Term of the finance (2012 OLDEST CAR WE FINANCE)*1 year2 years3 years4 years5 yearsWe finance cars over the following term,, 2012 car over 12 mths, 2013 car over 24 mths, 2014 car over 36 mths, 2015 car over 48 mths 2016,2017,2018 2019 car over 60 mths, New cars over 72 mths. EMPLOYMENT DETAILSOccupation*Employer Name & Address*Your monthly take home pay*€ Length of time with this employer*Central Credit RegistirCentral Credit Register If proceeding to an application, please read both of the following notifications. NOTICE: Under the Credit Reporting Act 2013 lenders are required to provide personal and credit information for credit applications and credit agreements of €500 and above to the Central Credit Register. This information will be held on the Central Credit Register and may be used by other lenders when making decisions on your credit applications and credit agreements. The Central Credit Register is maintained and operated by the Central Bank of Ireland. For information on your rights and duties under the Credit Reporting Act 2013 please refer to the factsheet prepared by the Central Bank of Ireland. This factsheet is available on www.centralcreditregister.ie. A Personal Public Service Number (PPSN) or other Tax Reference Number (TRN) must be verified for all applicants in advance of drawdown. Your Banking DetailsName and Address of Your Bank*Bank sort code*Bank Account Number*NameThis field is for validation purposes and should be left unchanged.