Loan Application Form V2-02-17 - Ne First Credit Union printable pdf download

BIRTLEY OFFICE

GATESHEAD OFFICE

Birtley Leisure Centre, Durham Road

11 Interchange Centre, West Street

Birtley, Co Durham DH3 2TB

Gateshead NE8 1BH

NORTH SHIELDS OFFICE

DURHAM OFFICE

72 Howard Street

136 Edge Court

Credit Union for the North East

North Shields NE30 1AF

Durham DH1 2XG

Web: rstcu.co.uk

Tel: 0330 055 3666

Loan application form

Loan Details:

Amount requested £ _______________ Repayment period ___________________ weeks / fortnights / months

Purpose of Loan ___________________________________________________________________________

Amount of Savings to be left throughout period of Loan £ _______ (N.B. This will not be able to be withdrawn)

How often do you intend to make loan repayments? (Please select)

Weekly / Every two weeks / Monthly

How will you make repayments?

Cash / Paypoint Card / Bank Standing Order / Payroll Deduction

If your application is successful how do you want to receive the loan? Cash / Cheque / BACS transfer to your bank

Bank details: Name _________________ Sort Code: _________________ Account No: ___________________

Member Details:

Name: ________________________________________

Membership No. _________________________

Address: ______________________________________

Postcode

_________________________

Telephone: ____________________________________

Date of birth

_________________________

Time at Present Address: ___________ No. of Dependent Children: _______ Partner's Name: ______________

Give previous address if less than 3 yrs: House number ________________ Postcode ____________________

Household make-up:

Applicant Only / Couple with no Children / Couple + Children / Lone Parent

Household Status:

Owner Occupied / Private Rented / L.A. Rented / H.Ass. Rented / Family or Friends

Employment Status:

Unemployed / Employed FT / Employed PT / Student / Retired / Self-employed

Name of employer: ______________________________

Time with employer __________________

Address of employer: ____________________________

Works ID No.

________________________

How Paid? Direct to Bank / Cash When? Weekly / Monthly

Bank details: Name _______________

Sort Code: _____________

Account No.: _________________

Have you got any Bad Debts or CCJs?

No / Yes - (Give Details on Reverse)

Where did you collect this form from? ____________________________________________________________

Declaration and Agreement:

Data Protection Statement: in accordance with the principles of the Data Protection Act 1998, I understand that NEFirst Credit Union Ltd

(NEFCU) will use my personal details for the purposes of managing my accounts with the credit union. My information will be treated as

con dential and only disclosed a) at my request, b) to NEFCU's agents in managing my accounts, c) in the public interest, d) to prevent fraud

or by order of the Courts. I also understand that, for a fee, I am entitled to a copy of the information held about me by applying in writing.

Important - Your Personal Information: NEFCU may use credit reference and fraud prevention agencies to help us make decisions.

A short guide to what we do and how both we and credit reference and fraud prevention agencies will use your information is detailed in

the lea et called: A condensed guide to the use of your personal information by ourselves and at Credit Reference and Fraud Prevention Agencies.

If you would like to read the full details of how your data may be used please visit our website at rst.co.uk or telephone 0330

055 3666 or ask one of our sta .

By con rming your agreement to proceed you are accepting that we may each use your information in this way.

Statement of Insurability: I declare that to the best of my knowledge and belief, I do not have a life threatening condition. I understand

that making a false declaration may a ect any insurance claim.

Declaration: I declare that the information I have given on this form (including the reverse) is, to the best of my knowledge and belief,

accurate and full information. I understand that the provision of false information that the credit union may take appropriate action if I am

found to have deliberately provided false or misleading information. I authorise NEFCU to make any credit reference or other enquiries in

accordance with their normal procedures in connection with this application.

I agree that if I default on repayments, information about my loan may be passed on to the Department for Work and Pensions for their

consideration of deductions from the bene ts that I am or will become entitled to.

Applicant's signature ________________________________________ Date ____________________

NEF/LAF/V2-02-17

Loan Application Form V2-02-17 - Ne First Credit Union

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