| The details which you provide within this application form are the basis of your disclosure. Credit Checks & Criminal Records Bureau Checks will be made and references taken, therefore the omission of any relevant details may result in your application being delayed. | |
| Title (If other, please state) | Mrs |
| All Forenames | Pauline |
| Surname | Bargh |
| Surname at birth | Pritchard |
| Date of birth | 01/05/1963 |
| National Insurance number | NA955134D |
| Home Tel | 01524936164 |
| Mobile Tel | 07947835381 |
| Other Telephone number | |
| Email Address (Your email address within the Firm - please do not use a personal email address) | pauline.bargh@janepartonmortgagestudio.co.uk |
| If applicable, please include below details of any other forenames and surnames used | |
| Previous Name(s) | Haddow |
| Date from | 02/04/1983 |
| Date to | 06/09/1997 |
| Reason(s) for change | Remarried |
| Previous Name(s) | Walton |
| Date from | 17/10/1975 |
| Date to | 02/04/1983 |
| Reason(s) for change | Married |
| Previous Name(s) | Pritchard |
| Date from | 01/05/1963 |
| Date to | 17/10/1975 |
| Reason(s) for change | Change of surname following adoption |