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Tel: 01837 658123

26 May 2017
Online Loan Application

If you require any help completing the form or would like to discuss your application please call the office on 01837 658123, we will be pleased to assist you.

1. Please read the form carefully and complete all sections. Please note that we use credit agencies to assist us in making our decision and by completing and submitting this form you are giving us permission to do a credit search.

2. If any of the following fields do not apply to you please enter N/A (meaning not applicable) or 0 if it relates to a value, you cannot leave any field blank.

3. On submission of your application you will receive a text letting you know that we have received your application. If your loan is agreed your loan paperwork will be sent to you by post along with a letter explaining what you need to do next.

4. Once you have submitted your application you will need to send us three months bank statements to (your loan will not be assessed until we have received these documents)



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

Application for Membership & Loan Form
* Required Fields
Members without savings can apply for a loan up to £500
Applicants Name: *
Address: *
Tel (home): *
Tel (mobile): *
Tel (work): *
E-mail Address: *
Date of Birth: *
Occupation: *
Employers Name: *
Work Address: *
Type of Accommodation: *
If living less than five years at present address, please state previous address: *
Please state the names of any other Credit Unions of which you have been a member: *
Consent to use disclosure/Data Protection Acts, 1988 and 2003 and Section 71 of the Credit union Act, 1997
I understand that under the Data Protection Acts, 1988 and 2003 (the ‘‘DPA’’), my consent may be required for the Credit Union to process personal data that it may have in its 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.
I also understand that under Section 71 of the Credit Union Act, 1997, the Credit Union, subject to exceptions listed in the Section, shall not disclose or permit to be disclosed, without my consent, any information that concerns an account or transaction of mine with the Credit Union.
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 accounts I have with the Credit Union, including any loan accounts I have from time to time with you:
1. I consent:
(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 from any credit reference bureau or agency 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 such credit union or any such credit reference bureau or agency;
(ii) to any Credit Union or any credit reference bureau or agency disclosing information to you concerning applications for loans and my credit history from the date of my original consent with any such Credit Union or otherwise;
(iii) to the processing of any information relating to me, either contained in this form or application, for the purpose of assessing applications and administering any accounts I maintain with the Credit Union.
2. From time to time, the Credit Union, or third parties selected by the Credit Union, may use your details to inform you of goods and/or services which may be of interest to you. The use of your details for marketing purposes will depend on the preferences that you express below:
Opt-In (marketing by email, text message and fax)
I consent to the Credit Union, or third parties selected by the Credit Union, informing me of goods or services that may be of interest to me by email, text message or fax: *Yes
Opt-Out (other forms of marketing)
Please tick the box opposite if you do not want the Credit Union, or third parties selected by the Credit Union to inform you by phone or letter of goods or services that may be of interest to you.: *Opt Out
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.
I hereby apply for membership of and agree to abide by the rules of the Credit Union and declare that the information given by me on this form is true and correct to the best of my knowledge and belif and that I am not, nor have been, a member of any credit union other than listed above.
Name: *
Date: *
To be completed by Parents or Guardians (if applicable)
* Required Fields
In the event that the application for membership is in respect of a person who is unable to give receipts:
I / we hereby apply for membership in the name of the said: *
And I / we acknowledge that all shares / deposits arising from this membership now and hereafter shall be his / her sole property and all withdrawals shall be applied to his / her sole benefit.
Signed: Parent(s) / Guardian(s) / Other: *
Employment Details
* Required Fields
Employer: *
Work Address: *
Occupation: *
Length of Service: *
Weekly Salary:£ *
Other Income:£ *
Payroll Number: *
Spouse/Partners Details (where relevant)
* Required Fields
Spouse/Partners Name: *
Spouse/Partners Employer: *
Employers Address: *
Spouse/Partners Occupation: *
Spouse/Partners Weekly Income:£ *
Any Other Income:£ *
Spouse/Partners Date of Birth: *
Outstanding debts or CCJs
* Required Fields
If you have any outstanding debts or CCJs we will not immediately exclude you from borrowing but we will do a credit check before making our decision and we will exclude anyone who has not declared all information on their application.
Have you any County Court Judgements made against you? (if yes please declare any amounts outstanding in the section below for current debts): *
Are you and undischarged bankrupt or are you in the process of applying for bankruptcy?: *
Income Expenditure
* Required Fields
Wages: *
Partners Wages: *
Job Seekers Allowance: *
Working Tax Credits: *
Child Tax Credits: *
Income Support: *
Incapacity Benefit: *
Pension: *
Child Benefit: *
Housing Benefit: *
Council Tax Benefit: *
DLA/Attendance: *
Mobility Allowance: *
Total: *
Rent /Mortgage: *
Service Charge: *
Council Tax: *
Contents Insurance: *
Life Insurance: *
Electricity (Suppliers?): *
Gas (Suppliers?): *
Water Rates: *
Landline Telephone: *
Mobile Phone: *
TV Rental: *
Sky/Cable: *
Internet: *
TV Licence: *
Food: *
Toiletries/Hair Cut: *
Laundrette: *
Clothes/Uniforms/Shoes: *
Bus/Trains/Petrol: *
Car Insurance: *
Road Tax: *
MOT & Other Car Costs: *
School Meals: *
Child Minding/Nursery: *
Maintenance: *
Entertainment: *
Pocket Money: *
Lottery: *
Cigarettes/Tobacco: *
Court Fees/fines: *
Catalogues: *
Store Cards: *
Loan Repayment:: *
Credit Cards: *
Christmas/Birthdays: *
Savings: *
Overdraft: *
Pet Expenses: *
Total: *
Current Financial Situation
* Required Fields
I declare that I am indebted to the following: *
Original AmountBalance OutstandingMonthly Repayment Amount
Bank/Building Society: *
£ £ £
Rent/Mortgage: *
£ £ £
Credit Card: *
£ £ £
Other: *
£ £ £
Previous Credit Union Loans *
AmountDateRepayment AmountsRepayment Frequency
1: *
2: *
3: *
Current Savings Balance(s):£ *
Current Loan Balance(s):£ *
Current Arrears:£ *
Loan Details
* Required Fields
I wish to apply for a loan of:£ *
Pupose of Loan: *
Date Required: *
To be repaid every: *
In installments of:£ *
* Required Fields
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: *I am in good health
I am NOT in good health
And that: *I am fit to follow my normal occupation
I am NOT fit to follow my normal occupation
Signature of Applicant: *
Date Signed: *
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
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