Uwi (Mona) & Community Co-Operative Credit Union Limited Loan Application - Personal Credit
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2UWI (MONA) & COMMUNITY CO-OPERATIVE CREDIT UNION LIMITED
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FOR INTERNAL USE ONLY
Branch/ Transit
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EAD
FFICE
ECH
Membership Number:
Date of Application:
1. PERSONAL INFORMATION
NAME OF APPLICANT (SURNAME, FIRST NAME, MIDDLE NAME)
DATE OF BIRTH (YYYY/MM/DD)
T.R.N
ACCOUNT #
CURRENT HOME ADDRESS
OWN. RENT. OTHER (Please specify)
YEARS THERE
MAILING ADDRESS IF DIFFERENT FROM HOME ADDRESS
HOME TELEPHONE #
FAX/CELLULAR #
PREVIOUS HOME ADDRESS
YEARS THERE
E-MAIL ADDRESS
NAME AND ADDRESS OF NEAREST RELATIVE NOT LIVING WITH YOU
RELATIONSHIP
TELEPHONE #
# OF DEPENDENTS
AGE (S) OF EACH
STATUS
DATE OF MEMBERSHIP (YYYY/MM/DD)
2. EMPLOYMENT INFORMATION
NAME OF EMPLOYER
YEARS THERE
OCCUPATION/TYPE OF BUSINESS
Permanent Temporary Contract Self Employed
ADDRESS OF EMPLOYER
EMPLOYEE #
TELEPHONE #
Contract Expiry Date (YYYY/MM/DD)
/
/
NAME OF PREVIOUS EMPLOYER
YEARS THERE
OCCUPATION/TYPE OF BUSINESS
Permanent Temporary Contract Self Employed
ADDRESS OF PREVIOUS EMPLOYER
TELEPHONE #
Contract Expiry Date (YYYY/MM/DD)
/
/
3. SPOUSE’S EMPLOYMENT INFORMATION
NAME OF SPOUSE (SURNAME, MAIDEN NAME (if applicable), FIRST NAME, MIDDLE NAME)
DATE OF BIRTH (YYYY/MM/DD)
T.R.N.
/
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NAME OF EMPLOYER
YEARS THERE
OCCUPATION/TYPE OF BUSINESS
ADDRESS OF EMPLOYER
TELEPHONE #
NAME OF PREVIOUS EMPLOYER
YEARS THERE
OCCUPATION/TYPE OF BUSINESS
ADDRESS OF PREVIOUS EMPLOYER
TELEPHONE #
4. CO-MAKERS / GUARANTOR’S (IF APPLICABLE)
Name 1:
Amount:
Name 2:
Amount:
Name 3:
Amount:
Name 4:
Amount:
Name 5:
Amount:
Name 5:
Amount:
5. LOAN DETAILS
REPAYMENT SOURCE:
LOAN PURPOSE
SALARY DEDUCTION
POST DATED CHEQUE
LOAN AMOUNT $
COUNTER
STANDING ORDER (ACCOUNT # & Institution)
COLLATERAL SECURITY HELD AND/ OR PROPOSED
Mortgage
$
Instrument of Charge
$
Insurance
$
Hypothecation
$
Bill of Sale
$
Other
$
6. INCOME AND EXPENDITURE STATEMENT
INCOME
$
EXPENDITURE
$
Gross Monthly Family Income
Car Loan Payment
Less Deduction At Source
Hire Purchase Payments
Net Income (Take Home Pay)
Life Insurance Premiums
Other Income
Other Loan Payments
TOTAL INCOME
Rent
Mortgage, Maintenance
Insurance, Home, Vehicle
Transportation Expenses
Utilities – Telephone, Water, Electricity
Living Expenses – Food, Clothing, etc.
Educational Expenses – School Fees, etc.
Medical, Dental, Optical Expenses
Entertainment
Other
TOTAL EXPENSES
SURPLUS (DEFICIT)
7. STATEMENT OF LIABILITIES
LIABILITIES
$
$
ASSETS
$
$
$
MORTGAGE
PAYMENTS
MONTHLY
BALANCE
REAL ESTATE (incl. address,
INSURANCE
MEMBER
LOANS OFFICER
PAYMENTS
OUTSTANDING
volume and folio numbers)
COVERAGE
VALUATION
VALUATION
(financial Institution, branch)
Current
AMOUNT
(Y/N)
LIEN HOLDER
CHATTELS (Motor vehicle,
Furniture, Equipment, Other)
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Parent category: Business