Loans in Derby Application

Note: ALL fields marked with an "*" are mandatory.

Title*
---MrMrsMsMiss

First Name*

Surname*

Date of Birth*

NI Number*

NOK (adult not living at same address)*

Any pre-existing medical conditions*

Address Details

House number & street name*

Town*

City*

Postcode*

Home Status*
---OwnerPrivate rentLA/HA rentFamily / friendsNFAOther

Time at address*
Years---0001020304050607080910+
Months---000102030405060708091011

House number & street name*

Town*

City*

Postcode*

Home Status*
---OwnerPrivate rentLA/HA rentFamily / friendsNFAOther

Time at address*
Years---0001020304050607080910+
Months---000102030405060708091011

House number & street name*

Town*

City*

Postcode*

Home Status*
---OwnerPrivate rentLA/HA rentFamily / friendsNFAOther

Time at address*
Years---0001020304050607080910+
Months---000102030405060708091011

Additional Details

Home Telephone*

Mobile Telephone*

Email Address*

No. of dependants*

Income Details

Work Status*
---UnemployedContractFulltimePart-time

Name of Employer*

Full address of Employer*

Tel. number of Employer*

Income Frequency*
---WeeklyMonthly

Salary/Wage amount*

Partners Income*

Benefits*

Pension*

Other*

Expenditure Details

Expenditure frequency*
---WeeklyMonthly

Rent/Mortgage*

Council Tax*

Electricity*

Gas*

Telephone*

Groceries*

Catalogues*

Credit Card(s)*

Hire Purchase*

Car*

Other Loan(s)*

Fares/Petrol*

Clothing*

Pension*

Savings*

Home Insurance*

Car Insurance*

Life Insurance*

Entertainment*

Other (specify)

Total Expenditure*

Income minus expenditure*

Loan Requirements

Loan Value*

Repayment frequency*
---WeeklyFortnightly4 weeklyMonthly

Loan Term*

Loan Purpose*
---HolidayFamily eventCar PurchaseCar taxCar insuranceCar repairsCarpetsHome improvementsDebt consolidationChristmas expensesHouse/bondRentFurnitureEducation/trainingUrgent billsCookerFridge/freezeWashing machineMaternity costsPayday advanceOther

If other, please state:

How do you want your loan paying to you?*
---BACSCheque

Declaration

I submit this application for a Credit Union Personal Loan and declare that the information that I have supplied is true and accurate. I also authorise you to make any enquiries you feel necessary for confirmation of the information contained in this application and for the purpose of credit assessment and affordability. This could include enquiries to substantiate details of income and expenditure that have been declared including contact with your employer and/or Landlord. Any agreement to provide the loan to which this application relates will be constituted as a credit agreement being signed by me and the credit union in accordance with the consumer credit act 1974; and that you may disclose information about me for the purposes of this application to other Credit Unions and their employees and agents for debt recovery purposes.

I understand that it is a criminal offence to obtain credit by deception, which can include the deliberate omission or creation of information within this application form.

I also understand that failure to maintain regular payments as required against my loan will resulting in action being taken to recover the monies outstanding.

I understand that I must save the compulsory minimum of £1 per week / £4 per month in a ‘Holding Savers’ account. I understand the savings in this account is secured against my loan.

I understand I may be asked for additional information such as bank statements to enable a decision to be made on my loan application.

I accept that if my loan is approved I will need to sign up as a Member and maintain a £1 share as my running balance in my main account.

I agreeI do not agree