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

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Amount of Savings to be left throughout period of Loan £ _______ (N.B. This will not be able to be withdrawn)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

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