Loan Application Form

All information is strictly confidential

Name:A value is required. Address: Telephone: Date of birth: Email:A value is required.Invalid format. Are you: Owner Tenant Living with Parents Date of joining: Membership number:

Amount Required: £ Present Share Balance: £ Present Loan Balance: £ Purpose of loan: Date loan required: Replayment period: Date of first payment: Security: Repayment Terms: Repayment: Weekly Fortnightly Monthly

I agree to save £ with every loan repayment (minimum £1)

Which method would you like to receive your loan?: Cash Bank transfer Name on Bank Account: Name of Bank: Sort Code: Account number:

		Weekly	Fortnighly	Monthly
Salary/Wages	£
State benefits	£
Pension	£
Other income	£

Total Income	£

	Expenses	Weekly	Fortnighly	Monthly
Rent/Mortgage	£
Council Tax	£
Gas/Electricity	£
Telephone	£
Housekeeping	£
Other Debts	£
Total Expenses	£

Proof of income will be asked for

Have you got a pre-existing illness? Yes No How long at present address? Years (if less than three years what was your previous address) Occupation: Employer's Name:: Employer's Address:: Employer's Conatct Number: Guarantor's Name (if required): Guarantor's Membership number: Guarantor's Address:

Please check box.I AM NOT INDEBTED TO ANY OTHER CREDIT UNION OR CREDITOR AS BORROWER OR GUARANTOR EXCEPT AS STATED