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Loan Application

Please fill in the form below and click on Send button. We will get back to you as soon as possible.

Full name:
Membership no.:
Address:
(if less than 3 years, please provide details of other addresses on the past 3 years in notes section below)
Post code:
Time at address:
Marital status:
Number of dependents:
Date of birth:
National Insurance no.:
Phone:
Employment status:

Occupation
(or benefit type):
Employer:
Work address:
Work phone:
Can contact you here? (check for yes)
Time with employer:
(If less than one year, please provide details in notes section below)
Loan purpose:
Date loan required:
Loan amount required:
Preferred re-payment period:
Amount to pay each period OR length of time preferred: (e.g please enter '£' or 'weeks')

Outgoings:

 Weekly Monthly

Income:

 Weekly Monthly
Rent/Mortgage: Salary/earnings:
Council: Partner's income:
Electricity: Benefits:
Gas: Pension:
Telephone:
Groceries:  
Loans:    
Clothing:      
Car Insurance:      
Life Insurance:      
CU loan & share paym't :      
     
     
Notes:

Declaration

Data Protection Statement: In accordance with the principles of the Data Protection Act 1998, we will use your personal details for the purposes of managing your accounts with the credit union. Your personal details will be treated confidentially and will only be shared with other agencies for the purposes of credit referencing and debt recovery, for which purpose we hold a Category F Consumer Credit licence. If you request it, we may at times use your details to keep you informed of services available from the credit union.

If you have declared your partner’s income details as part of your overall income in applying for this loan, your partner will need to sign a form we supply confirming agreement for their information to be used in considering the loan and its repayment.

I declare that the information I have given on this form is, to the best of my knowledge and belief, accurate and full information. I am not indebted to any other credit union, bank, or loan agency, either as borrower or guarantor, except as stated above. I understand that the provision of false information is fraud and that the credit union may take appropriate action if I am found to have deliberately provided false or misleading information.
I agree to the above declaration:
I would like to be kept informed of PCU news and services:
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