Illustration form

Illustration request form

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Advisor details

Are you registered with the West Brom for intermediaries?


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

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Product details

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.
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Intermediary fee

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Leave this field blank if you selected 'No' to the question above.
Is the fee refundable?


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

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.

Example format: '00-00-00'
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Example format: '1234'
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West Bromwich Building Society - Head Office, 2 Providence Place, West Bromwich, B70 8AF. The West Brom is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Register No:104877. 'the West Brom' and 'the West Brom for intermediaries' are trading names of West Bromwich Building Society.

This site is for professional intermediaries only.