CU Personal Loan Application Form

I hereby apply for a loan of
CU Personal Loan Application Form
Loan Category
Personal
€
(please select one)
DBusiness 0
Home Improvement
_
Loan term required (years)
0
Mortgage
0
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Weekly I Bi-weekly I Monthly Repayments
Specific Loan Purpose
Intended use of loon
of€
_
Plus Interest I Including Interest
Member 2 I Spouse I Civil Partner! Business Partner (Circle)
Personal Details
Member!
Member no
Member no
Title (circle one) Mr Mrs Miss Ms Other
Title (circle one) Mr Mrs Miss Ms Other
Status (circle one) Married I Civil Partnership I Single I Other
Surname
Surname
First Name
First Name
Former
Former
Date of Birth
Date of Birth
Address
Address
Time at present
Address
I Years
Time at present
Address
I Years
Residential status
0
Residential status
D House owner D Renting
D
Months
House owner
Buying
D
D
Renting
D
At Home
Months
Buying
D
Previous address
(If less than 2 years)
Previous address
(If less than 2 years)
Time at Address
I Years
Phone Number
I Home
I Mobile
Westport Credit Union
Months
Time at Address
I Years
Phone Number
!Home
I Mobile
Months
At Home
CU PERSONAL
LOAN APPLICATION
FROM
Member2 I Spouse I Civil Partner I Business Partner (Circle)
Employment Details
Member I
Employer Name
Employer Name
Employer Address
Employer Address
Phone Number
Phone Number
Employment
I Occupation
Employment
Occupation
Position
Position
Length of time
Length of time
Full Time Employment
D
Fixed Term Employment
D
Part Time Employment
D
Full Time Employment
D
Fixed Term Employment
D
Part Time Employment
Provide length of fixed term contract
Provide length of fixed term contract
Previous Employer
Name
(If less than 2 years)
Previous Employer
Name
(If less than 2 years)
Employer Address
Employer Address
Phone Number
Phone Number
Employment
I Occupation
I
Employment
Position
Occupation
Positron
I Length of time
Length of time
I Freyuenc.y
Current Salary! Profit
1€
Rental Income from
Investment Property
1€
I
Fre4uency w f m
Social Welfare
1€
I
Frequency"
w f'm
rm I
Current Salary! Profit
Rental Income from
Investment Property
Social Welfare
**please attach evidence of income, i.e payslips for salary & wages, Last set of accounts together with tax assessment
for self-employed, social welfare slips (see checklist).
D
CU Personal
Loan Application
Form
Liabilities (what you owe)
Member 1
Member 2 /Spouse/ Civil Partner/ BusinessPartner (Circle)
Name of Mortgage Company (Principal property address}
I
I
Member 1
Member2
Monthly repayments
I
€
Amount outstanding
I
€
Amount outstanding
Original amount borrowed
I
€
Original amount borrowed
Date Borrowed
Type (please tick)
D
I I
variable
I
Monthly repayments
Term
D
fixed
Date Borrowed
D
tracker
I
Type (please tick)D
_€
__.
_€
__.
_€
__.
L...I
._I
I
I
L...I
Term
J
variableO
fixed D
If fixed, please give date that it is fixed to
If fixed, please give date that it is fixed to
Are you on interest only facility
Are you on interest only facility
YESD
tracker
NOD
Name of Mortgage Company (Investment property address}
I
Member 1
J
Member 2
Monthly repayments
Monthly repayments
€
Amount outstanding
Amount outstanding
€
Original amount borrowed
€
Original amount borrowed
Date Borrowed
Type (please tick} D
€
I I
Term
variable D
fixed
If fixed, please give date that it is fixed to
Date Borrowed
D
tracker
I
Type (please tick}D
I I
variableD
Term
fixed D
If fixed, please give date that it is fixed to
Personal Loans (Lender Name & Purpose)
I
Member 1
Member2
Monthly repayment
Amount outstanding
Date Borrowed
I I
Westport Credit Union Limited
€
Monthly repayment
€
Amount outstanding
Term
Date Borrowed
I I
Term
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CU Personal Loan Applicatio
n Form
Personal Loans (Lender Name & Purpose)
j
Member 1
Member 2
Monthly repayment
Amount outstanding
Date Borrowed
€
Monthly repayment
€
€
Amount outstanding
€
I I
Term
Date Borrowed
Term
I I
Credit Cards (include all cards even if balance is nil)
I
Member 1 card details
Member 2 card details
Monthly repayment
€
Amount outstanding
Amount outstanding
€
Credit Limit of card
I
Monthly repayment
Credit Limit on Card
€
j
Member 1 card details
Monthly repayment
Amount outstanding
Credit Limit of card
€
€
€
Member 2 card details
€
Monthly repayment
€
€
Amount outstanding
€
€
Credit Limit of card
€
Other Details
Member 1
Member 2 /Spouse/ Civil Partner/ Business Partner(Circle)
(Do not show dependents counted by first applicant)
Number of dependents
D
Number of dependents
AgesDDDDD
Are you a guarantor for any loan?
If yes, please give details
AgesDDDDD
D
YIN
Are you a guarantor for any loan? DY IN
If yes, please give details
Financial Institution
Financial Institution
Amount of Loan €
Amount of Loan €
Monthly Repayment€
Monthly Repayment€
Westport Credit Union Limited
D
CU Personal
D
Loan Application
Car loan (Car Registration
Form
Certificate
& Purchase
Invoice)
Year
Make& Model
Insurance renewal date
Insurance Type
Vendor
Trade in details (if any)
D
Home
I
Insurance cost€
Improvement
Address of property
c
Value of Property
Is the property mortgaged? (Please circle as appropriate)
Monthly repayment€
Y/N
Insurance renewal date
Insurance cost€
I
Name of Mortgage Lender
Current Balance€
a/c #
Contractor Name & Address
Quotation Supplied
Y/N
Brief description of works
Security available
D
Guarantor (circle
as appropriate)
Name of Guarantor
Full Address of Guarantor
Relationship to Member
I
y /N
Member of Credit Union
Employment Status
Fulltime
Home Owner
Port-time
I
Y/N
Contract
Phone Number
Self-employed
Other
Repayment Protection Details
D
RPI Taken
Initial
Protection
The benefits
Member
._I
of Repayment
Yes
_€
__,
Protection
Signature
Date
Westport Credit Union Limited
Insurance
have been
explained
to me. I wish to protect
my repayments.
CU Personal Loan Application Form
Personal Loans (Lender Name & Purpose)
I
Member 1
Member 2
Monthly repayment
Amount outstanding
Date Borrowed
€
Monthly repayment
€
€
Amount outstanding
€
I I
Term
Date Borrowed
Term
I I
Credit Cards (include all cards even if balance is nil)
I
Member 1 card details
Member 2 card details
c
Monthly repayment
Amount outstanding
Amount outstanding
€
Credit Limit of card
I
Monthly repayment
Credit Limit on Card
€
I
Member 1 card details
Monthly repayment
Credit Lim it of ca rd
€
Member 2 card details
€
€
Amount outstanding
€
€
Credit Limitof card
€
Other Details
Member 1
Number of dependents
€
Monthly repayment
€
Amount outstanding
€
Member2 /Spouse/ Civil Partner/ Business Partner (Circle)
(Do not show dependents counted by first applicant)
D
Number of dependents
AgesDDDDD
Are you a guarantor for any loan? D
If yes, please give details
AgesDDDDD
YIN
Are you a guarantor for any loan? DY IN
If yes, please give details
Financial Institution
Financial Institution
Amount of Loan€
Amount of Loan €
Monthly Repayment€
Monthly Repayment€
WestportCredit Union Limited
D
CU Personal Loan Application Form
Loan Application Checklist:
Please return the completed loan application
with supporting information.
NameofMemberl~~~~~~~~~~~
EMPLOYED/UNEMPLOYED
P60
Salary Certificate
Payslip (3 most recent)
DSP Payslip (3 most recent)
Member 1
Member2
0
0
0
0
0
0
0
0
Member 1
Member2
0
0
()
o
SELF EMPLOYED
Audited Accounts
Confirmation of Tax Affairs
Most recent Tax assessment
Personal bank statements 3 months (most recent)
Loan statements (other than credit union)
Proof of savings (other than credit union)
Mortgage statement
Credit Card statements
0
0
Member 1
Member2
0
0
0
0
0
0
0
0
Photo ID*
Proof of Address (in date utility bill)*
~ The Criminal Justice (Money Laundering and Terrorist Financing) Act, 2010 obligates credit unions to establish the identity of its
members. This is undertaken by the credit union in requiring members to present proof of their name, residential address and date
of birth. Documentation accepted by the credit union is as follows;
One official government documentation containing a photo verifying the name (and date of birth) to include
•
In date drivers licence
•
In date passport
•
In date MllO form
•
National Identity card
Supporting documentation verifying address to include:
•
Utility bill (no older than eight weeks)
•
Household or motor insurance certificate
local authority document
•
Official documentation issued by the Revenue Commissioners
or Department of Social Protection
Please make sure that the loan form is completed in full to ensure a timely decision on your loan application.
member of staff for assistance with the above.
Please contact any
Approved By
Westport Credit Union Limited
9
CU PERSONAL
LOAN APPLICATION
FROM
Breadwinner Protection Details
If you are not in full-time employment, you can still avail of Repayment Protection Insurance. Your repayments will be protected in the event of the breadwinner below
becoming ill or redundant.
Name
Date of Birth
Data Protection (consent to use and disclosure/Data
Protection Acts 1988 and 2003 and Section 71 of the Credit Union Acts, 1997- 2012)
undersigned that under the Data Protection Acts. 1988 and 2003 ("the DPA"). my consent nay be required for the credit union to process personal data
which it may have in it's possession concerning e (including disclosure to third parties). I note that this personal data may include sensitive personal data
within the meaning of the DPA, the processing of which requires my explicit consent. I also understand that under Section 71 of the Credit Union Acts,
1997-2012, the credit union, subject to exceptions listed in the Section, shall not disclose or permit to be disclosed, without my consent, any information
that concerns an account or transaction of mine with the credit union. For the purpose of assign any applications (including loan applications) which I
may make to you and for generally administering and monitoring any accounts T have with the credit union. including the loan account if granted and
any other loan account I have from time to time with you I consent:
(i) to you seeking information concerning application for loans and any credit history from any credit union and from any credit reference bureau or
agency operated or arranged by the Irish League of Credit Unions and for that purpose you may disclose any information in this application or
which you may have concerning me to any credit union or to any such credit reference bureau or agency; and
(ii) to any credit union or an credit reference bureau or agency operated by the Irish League of Credit Unions disclosing information concerning
applications for loans and my credit history with any credit union or otherwise; and
(iii) to the disclosing of any information in any application (including loan applications) or in respect of any account or transaction on mine with the
credit union from the date of my original consent to officers or employees of the Irish League of Credit Unions for the purpose of fulfilling our
requirements and under the Savings Protections Scheme if such scheme is operated on behalf of the Credit Union by The Irish League of Credit Unions;
an<l (iv) to the processing of any information relating lo me, either contained in this form or otherwise, for the purpose of assessing applications and
administering any accounts I maintain with the credit union.
From time to time, the credit union. or third parties selected by the credit union, any use your details to in.form you of goods and/services which may be
on interest to you. The use of your details for marketing purposes will depend on the preferences that you express below:
O
Opt in (marketing by phone, email, text message and fax)
] consent to the credit union, or third parties selected by the credit union, informing me of goods or services that may be of interest to me.
o
Opt out (marketing by phone, email, text message and fax)
Please tick the box opposite if you not want the credit union or third parties selected
of interest to you.
by the credit union,
to inform you by phone or letter of goods or services that may be
Please note that you have the right to access personal data held about you by the credit union and to correct any inaccuracies in such data.
Declaration
• I am not indebted to any other credit union, bank or loan agency either as a borrower or guarantor, except as stated above.
•I confirm that I have the financial means to repay this loan.
• It has been explained to me that my shares will be held as security for this loan.
I I We have read and understood the particulars which have been completed in this application and declare that they are true, correct and contain no material omission and
have been made to the credit union to enable them to determine whether or not to grant the application and if so, the terms and conditions on which the loan will be offered,
approved or granted
1 I We understand that this is an application and as such does not imply that a loan will be offered, approved or granted.
Member l
Member l
Print Name
Print Name
J
Date
Witness
Witness
Print Name
Print Name
J
Date
Irish Credit Bureau Consent
I/We authorise
Westport Credit Union limited to process and retain data provided by me/us in respect of this application, to seek and provide credit references
(searches), to record details of any transaction which may result from this application with Irish Credit Bureau Limited and !CB to record, retain and disclose to it's members
details of such searches for a period of one year and for monitoring the loan if granted, I/We acknowledge that Westport Credit Union limited and/or the !CB are permitted to
disclose any material misstatement of the fact contained in the application for financial accommodation to it's members and relevant bodies. I/We consent to any such
application being processed, recorded and retained by ICB.
Member2
Member 1
J
Date
J
Date