Loan Application Form

Loans Existing Member Loan Application

Please complete all your details in the form below, and click submit when you have finished.

Existing Member - Loan Application Form

* Required Fields
Personal Details
4 Digit Member No:	*
First Name:	*
Middle Name:
Surname:	*
Date of birth DD/MM/YY:	*
National Insurance No:	*
No of dependant children:	*
Ages:

Current Address

* Required Fields
Number or house name:	*
Line 2:	*
Town:
City:
Postcode:	*
Years at address?	*
Household Status:	*
If Local authority or housing association please state:
Marital Status:	*
If you have lived at your current address for less than 3 years please give us your previous address below
Previous Address
Number or house name:
Line 2:
Town:
City:
Postcode:
Years at address?

Contact Details

* Required Fields
Home Phone:	*
Mobile Phone:	*
Email:	*
How would you like us to contact you? * Post E-Mail SMS

Employment Details

* Required Fields
Employment Status:	*
Occupation:
Employers Name:
Address:
How long have you been working for your current employer:
Work Telephone:

Payroll Deduction

* Required Fields
If you work for a participating employer and you wish to take advantage of our Payroll Loans, you must have your repayments deducted through your salary. Please provide us with your Employer and payroll number below.
Select your employer:	*
Payroll Number:
What is your Monthly Pay Date:
I authorise Credit Union to arrange deductions from my wages or salary should I be accepted for this loan beginning from the first possible pay day after signing my credit agreement until instructed otherwise. I authorise Credit Union to be notified of my leaving or termination of employment date.: * Yes

Bank details

* Required Fields
We will store these details securely for your convenience should you wish to transfer money from your Credit Union account.
Sort Code:	*
Account Number:	*
Related to any officer of the credit union?

Telephone Banking Member Security code

* Required Fields
Please insert your memorable name registered with us. If this has not yet been set in place, please insert a memorable name of up to 10 characters with a mixture of letters and numbers. This will allow you to access your account by telephone to make enquires and arrange transfers:	*

Loan Application Form

* Required Fields
What type of loan are you looking for:
To view eligibility for loan types click here.
Amount Requested:	*
Purpose of Loan:	*
Repayments to be made over:	*
Please choose:	*
To view Loan Calculator click here.
Income - Monthly
Monthly Wages:
Wages (Partner):
Children’s contributions:
Child Benefit:
Income Support or JSA Incapacity:
DLA or PIP:
Tax Credits:
Pension:
Universal Credit:
Housing benefit:
Other:
All loans issued must have a direct payment in place to meet the loan repayments
Please select which payment you will set in place:
Expenditure - Monthly Expenditure
Monthly Rent/Mortgage:
Monthly Other Debts (e.g. loans/credit cards/payday loans):
Do you have any CCJs, Charging Orders or Default Notices?
Are you an undischarged bankrupt/IVA?

Data Protection

* Required Fields
I understand that under the Data Protection Acts, 1988 ("the "DPA"), my consent may be required for the Credit Union to process personal data which it may have in it's possession concerning me (including disclosure to third parties). I note that this personal data may include sensitive personal data, such as data about my health, within the meaning of the DPA, the processing of which requires my explicit consent.
For the purpose of assessing my application for membership, assessing any loan applications which I may make to you and generally for administering and monitoring any
1 (i) to you seeking information concerning applications for loans and my credit history from the date of my original consent from any Credit Union and for that purpose you may disclose any relevant information in any loan application which I may make to you or which you may have concerning me to any Credit Union;
(ii) to any Credit Union disclosing information to you concerning applications for loans and my credit history from the date of my original consent with any such Credit Union;
(iii) to you disclosing of any information in any application (including loan applications) or in respect of any account or transaction of mine with the Credit Union from the date of my original consent to officers or employees of the Financial Services Compensation Scheme(FSCS) the purpose of fulfilling our statutory requirements.
(iv) to the processing of any information relating to me, either contained in this form or any other form or application, for the purpose of assessing applications and administering any accounts I maintain with the Credit Union.
Please note that you have the right to access personal data held about you by the credit union and to correct any inaccuracies in such data.
You will be given a decision in principle and if successful or should further underwriting be required, you will be asked to submit some of the following documents.
1: Last 3 months of payslips
2: Last 3 months original bank statements
3: Benefit entitlement letter
4: Paperwork regarding bankruptcy, CCJ’s
5: Paperwork of existing debts (ie credit cards, loans, hire purchase)
Signature:	*
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