Please note: If you’re not already a member of The Co-op Credit union, you’ll first need to complete the membership application form here
Title (Mr/Mrs/Miss/Ms) (required)
First Name (required)
Home Address (required)
Post Code (required)
Date of Birth (applicants must be 18 yrs or over) (required)
No. of Dependants (required)
Time at Current Address (required)
(If less than 3 years, please provide details of your previous address)
Type of Accommodation (required) ---OwnerTenantWith ParentsLodger
If Owned, Approx Value £
If Mortgaged, Approx Mortgage £
Employer Address (required)
Date Employement Commenced
Employment Time ---Full-timePart-time
Loan Amount Requested (required) £
Loan Duration (Months/4wkly pay periods) (required)
Purpose of Loan (required)
Estimated Total Cost (required) £
I wish to continue to save (required) £
per month/4 weeks
You must continue to save a minimum of £10 per month/4 weeks in your main share account whilst repaying your loan. The savings in the share account will not be available for withdrawal until the loan balance is lower than the savings balance.
Account No. (required)
Sort Code (required)
Please complete the following section to the best of your knowledge.
Income (£ per month - Net)
Other: (please specify)
Total Income: (required)
Expenditure (£ per month)
Rent/Mortgage: Outstanding Balance: Value of Assets:
Catalogues: Outstanding Balance:
Credit Cards: Outstanding Balance:
Hire Purchases: Outstanding Balance:
Car Loan: Outstanding Balance:
Other Loans: Outstanding Balance:
Savings/Investments: Value of Assets:
Other: (please specify) Outstanding Balance: Value of Assets:
Total Expenditure: (required)
If you are subject to any of the following, please tick the relevant box and provide further information:
County Court JudgementUndischarged BankruptMortgage/Loan ArrearsIndividual Voluntary ArrangementCurrently on Sick/Maternity Leave
I declare that:
I further declare the information given on this form is accurate and correct. I understand that the provision of false information is fraud and that in the event I am found to have deliberately falsified information, appropriate action may be taken.
I agree to the above declaration.
I acknowledge that I may be asked to supply my most recent 3 months bank statements and wage slips.
Please tick this box to confirm that you have read our terms and conditions detailing how we will use your information in relation to credit reference agencies, which can be found on our terms & conditions page
Join Your Credit Union
Check to see if you are a winner! Not a member yet? Apply to join The Co-op Credit Union today.