Illustration Request Form

Complete the fields below ensuring you have the applicant(s) personal information (including the mortgage account number and the sort code and last four digits of their bank/building society account number the mortgage is paid from) and property details. When you’ve entered all of the required information, submit your request to us. We will confirm receipt of your request by email.

Please enter all details manually to prevent autofill from completing fields incorrectly.

Advisor details

Are you registered with the West Brom for intermediaries? Yes No

Please note, if you are not registered, upon submitting this form one of our team will contact you to arrange your registration.

First name: Surname: Company:

If you are Directly Authorised, please include your company name and Mortgage Club in this field and select Directly Authorised from the Network field below. We are working with a limited number of brokers through the mortgage clubs listed and not currently expanding our distribution to the wider market at this stage.

Network: FCA Firm Reference Number: Email address: Telephone number:

Applicant details

Mortgage account number:

This is the 901 number that will be on your client’s annual mortgage statement. It should consist of 9 numbers.

Type of mortgage:

Please specify the reason you are unable to use the broker portal:

Applicant 1 full name: Applicant 2 full name: Address line 1: Address line 2: Town/City: Postcode:

Product details

Product code(s) of the new product(s):

Maximum of four product codes allowed. When entering multiple codes, separate each product code by comma (e.g. 14875, 14866, 14872, 14879).

Please note, we reserve the right to withdraw this product(s) at any time prior to transferring the mortgage.

Further advance

Is a further advance required?

If no then proceed to "Intermediary fee" section

Reason for the further advance: Total further advance amount required:

Mortgage term required:

Years: Months:

Round down the term of the further advance to the nearest whole year in line with the existing term

e.g. Existing term 21 years 7 months, the new further advance term would be 21 years exactly.

The further advance term cannot exceed the existing mortgage term.

Further advance repayment type Valuation If the further advance is for home improvements, please state what you believe the valuation to be once the works have been completed: Product code(s) for the further advance product(s):

Maximum of four product codes allowed. When entering multiple codes, separate each product code by comma (e.g. 14875, 14866, 14872, 14879).

Please note, we reserve the right to withdraw this product(s) at any time prior to submission of the application.

Intermediary fee

Is there an intermediary fee? Fee amount for the rate switch:

Leave this field blank if you selected 'No' to the question above.

Rate switch fee type Is the rate switch fee refundable? Yes No N/A

Select 'N/A' if you selected 'No' to the 'Is there an intermediary fee' question.

Fee amount for the further advance:

Leave this field blank if you selected 'No' to "Is there an intermediary fee?"

Further advance fee type Is the further advance fee refundable? Yes No N/A

Select 'N/A' if you selected 'No' to the "Is there an intermediary fee?" question.

Sub accounts

Does the applicant have more than one sub account?

Does the applicant wish to switch all accounts? What is the rate for the account the applicant wishes to switch?

Supporting information

Any other supporting information?

Security questions

In order for us to validate your client’s authority you will need to provide us with your client's sort code and the last 4 digits of their account number relating to the bank/building society account the mortgage is paid from. Please note that failure to provide this information will mean that we will not be able to release the requested mortgage account information.

Sort code:

Example format: '00-00-00'

Last 4 digits of account number:

Example format: '1234'

Before submitting your request, please check that all details have been entered correctly.