Loan Application Form

If you’d prefer, you can download a copy of the form. Please fill it in and return it to us in branch.

Member Details

Membership Number

Full Name(Required)

Address(Required)

Street Address Address Line 2 City ZIP / Postal Code

Time at Current Address(Required)

No. of Dependants(Required)

Phone Number(Required)

Mobile Number

Email Address(Required)

Date of Birth(Required)

Personal Status(Required)

Residential Status(Required)

Employment

Employment Status(Required)

Job Title

Employer Name

Employer Address

Street Address Address Line 2 City ZIP / Postal Code

Telephone Number

Employment Status

No. of years employed

Bank Details

Bank Name(Required)

Branch(Required)

Sort Code(Required)

Account Number(Required)

Financial Details

Do you have Decrees outstanding?(Required)

Are you subject to a valid Trust Deed?(Required)

Are you an un-discharged bankrupt?(Required)

Your Income

Wages / Salary(Required)

Partners Contribution

Child Support

Child Benefit

Child Tax Credit

Working Tax Credit

Employment & Support Allowance (ESA)

Personal Independence Payment (PIP)

Carers Allowance (CA)

Universal Credit (UC)

Pension

Interest on Savings / Investments

Other Income (Please Specify)

Total Income(Required)

Your Expenditure

Rent / Mortgage

Council Tax

Gas & Electricity

TV License

Telephone (Landline)

Telephone (Mobile)

Entertainment / TV

Car / Travel Expenses

Groceries

Credit & Store Cards

Catalogues

Hire Purchase

Bank Loan Repayments

Credit Union Loan Repayment

Insurance

Childcare

Housekeeping / Maintenance

Pension

Total Expenditure(Required)

Disposable Income(Required)

Loan Details

Purpose of Loan(Required)

Date Loan Required(Required)

Share Balance(Required)

Current Loan Balance(Required)

New Amount Requested(Required)

Total Loan Balance(Required)

Proposed Method of Payment(Required)

First Repayment Date(Required)

Repayment Frequency(Required)

Repayment Amount(Required)

Save with each loan repayment

Total Repayment Value(Required)

Health Declaration

Have you received, in the last 6 months, medical attention for a condition which is or could be considered life threatening?(Required)

Partners Declaration

If you have declared your partners income details as part of your overall income in applying for this loan, your partner will need to sign below confirming agreement for their information to be used in considering the loan and its repayment.

Signature

Date

Formal Declaration

I declare that the information I have given on this form is, to the best of my knowledge and belief, accurate. I understand that the provision of false or misleading information is fraud and that the Credit Union may take appropriate action if I am found to have deliberately provided false or misleading information. By signing this form, I agree that the Credit Union may carry out a credit check with an external credit reference agency.

Applicants Full Name(Required)

Signature

Date(Required)