Online Loan Application

Account Number:

Member Name:

Member Address:

Previous Address (If less than 3 years):

Type of Accommodation:

If Other, please specify:

Tel Home:

Tel Work:

E-mail Address:

Date of Birth:

Marital Status:

Number of Dependants:

Employer:

Work Address:

Occupation:

Length of Service:

Weekly Salary:

Other Income:

Payroll Number:

E-mail Address:

Spouse/Partners Name:

Spouse/Partners Employer:

Employers Address:

Spouse/Partners Occupation:

Spouse/Partners Weekly Income:

Any Other Income:

Spouse/Partners Date of Birth:

Bank/Building Society:

Rent/Mortgage:

Credit Card:

Other:

1:

2:

3:

Current Savings Balance(s):

Current Loan Balance(s):

Current Arrears:

I wish to apply for a loan of:

Pupose of Loan:

Date Required:

To be repayed every:

In installments of:

I declare that I am not indebted to any other Credit Union, Bank or Loan Agency either as a borrower or Guarantor, except as stated on this application. The statements herein are made for the purposes of obtaining the loan and are true to the best of my knowlewdge and belief.

I declare that to the best of my knowledge: *

And that: *

Signature of Applicant:

Date Signed:

Name of Guarantor (if required):

Guarantors relationship to Applicant:

Data Protection Act 1988 - I consent to the information contained in this application form being used by the Credit Union for the purposes of processing my application