Loan Application

    Personal Details:

    Surname (Mr/Mrs/Miss/Mssss) (required)

    First Name (required)

    Middle Name

    Membership No.

    Home Address

    Post Code

    Home Tel

    Work Tel

    Mobile Tel

    Email

    Date of Birth (applicants must be 18 yrs or over) (required)

    National Insurance Number

    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)

    If Owned, Approx Value £

    If Mortgaged, Approx Mortgage £

    Mortgage Provider

    Term Remaining

    Employment Details:

    Employee/Payroll No. (required)

    Pension No.

    Employer (required)

    Dept. (required)

    Employer Address (required)

    Post Code

    Manchester Sites:

    Floor

    Building

    Date Employement Commenced

    Employment Time

    Loan Details:

    Loan Amount Requested (required) £

    Loan Duration (Months/4wkly pay periods) (required)

    Purpose of Loan

    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 withdrawl until the loan balance is lower than the savings balance.

    Please indicate how you would like to recieve the monies:

    Account Name

    Account No. (required)

    Sort Code (required)

    Financial Details:

    Total Income Per Month (Net) (required) £

    (e.g; Salary, Pension, Benefits, etc.)

    Total Expenditure Per Month (required) £

    (e.g; Rent, Loans, Credit Cards, Groceries, etc.)

    If you are subject to any of the following, plaese tick the relevant box and provide further information:

    Declaration (Important - Please Read Carefully)

    I declare that:

    • To the best of my knowledge I am in good health and fit to carry out my normal occupation.

    • I am not indebted to any other Credit Union, bank or loan agency as a borrower, guarantor or surety except as stated above.

    • Neither I nor any company which I am a shareholder or director is the subject of any bankruptcy or insolvency proceeding or interim administration order either now or pending or threatened pursuant to the Insolvency Act 1986.

    • I have not served or been served notice of termination of my employment.

    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, approprate action may be taken.

    I agree to the above declaration.

    Co-operative Credit Footer logos