Please completeallsections of the form in BLOCK CAPITALS. If you need any help in completing the form, staff or volunteers in the Credit Union will be pleased to assist.
Member Details:
Name…………………………………………………………..Mr/Mrs/MissMembership Number……………......Address……………………………………………………………………………………………………………………......
………………………...... Postcode…………………...... Nationality......
Time at current address…...... (If less than 3 years, please provide details of other addresses in the past 3 years
......
Date of Birth …………………National Insurance Number………………..……. Ages of dependant children……......
Home Telephone Number…………………………...MobileTelephone Number(s)………………………………......
Email address ......
Marital Status: Married Single With Partner Widow Divorced Separated
Loan Details
Amount Requested £ ………………………. Purpose of Loan?......Employment / Benefit Details:
Employment status (Please tick) Unemployed Employed Retired Self Employed Occupation or type of benefit received.…………………………………………………………………………………
Name of employer…………………………………………………………………………………………………………
Address of employer………………………………………………………………………………………………………
Work phone number……………………………………….Can you be contacted here?Yes No
Time with current employer………………………(If less than one year, please give details of previous employment) ……………………………………………………………………………………………………………………………….
Please tick the appropriate box: Are you a tenant? Are you a lodger? Living with parents? Buying your house? Own your own house?
Do you have or have you had any County Court Judgements, debt problems or arrears?Yes No
Please note, this does not automatically mean your loan application will be refused.
If yes, please provide details in this box:
Official Use Only
A loan of £…………………… was APPROVED / REFUSED on……………..day of …………...... 20……...ALD Status:…………………… Additional Comments: ......
………………………………………………………………………………………………………………………………
Authorised signatory……………………….…………….Authorised Signatory…………………………………..……..
Income / £ per
week / £ per month / Expenditure / £ per
week / £ per
month
Salary / wages / Rent / Mortgage
Partner’s income* / Council Tax
Pension / Gas / Oil / Coal
Other income / Electricity
Benefits
(please specify) / Water Rates
Loans / HP Repayments
Store Cards
Catalogue Repayments
Credit Cards
Home Telephone
Mobile Telephone
TV Licence / Sky / Cable
Food / Shopping
Cigarettes
School Meals
Childminding
Clothes / Uniforms / Shoes
Car Insurance
TOTAL / Road Tax
Official Use Only: / Petrol
DISPOSABLE INCOME SUMMARY / Bus / Taxi Fares
Weekly / Monthly / Eating Out / Entertainment
TOTAL INCOME / Lottery
Christmas / Birthdays
TOTAL EXPENDITURE / Hobbies
Savings / Pension Payment
SURPLUS INCOME / Other (please specify)
TOTAL
Formal Declaration – Please read carefully before signing this application
I have read and fully understand the Data Protection Statement overleaf Please tick.Are you receiving, or have you received in the last six months, medical advice, consultation or treatment for any serious illness or injury? Yes No .
The statements made and information provided on this form are made for the purpose of obtaining the loan and are true to the best of my knowledge and belief. I understand that the provision of false information is fraud and that the credit union may take appropriate action if I am found to have deliberately provided false or misleading information.
REMINDER: Have you provided 3 months Bank Statements and Proof of Income?
Applicants Signature……………………………………………Date ……………………………………
*If you have declared your partner’s income details as part of your overall income in applying for this loan, your partner will need to sign below confirming agreement for their information to be used in considering the loan and its repayment.
Partner’s Name……………………………………………Partner’s Signature……………………………………
Method of Payment
Duration of Loan: 12 months 24 months or 36 months Repayment amount £…………...... Repayment period: Weekly Fortnightly or Monthly
Cash cheque (Passport or Driving Licence required) or Cheque made payable to: ……………………………..…......
For BACS (internet transfer) Please state: Account Number:……………………….SortCode:…………………………..
Ref. FRN 213956 : Authorised and Registered by the Financial Conduct Authority and overseen by the Financial Ombudsman Service. Issue 6 – 29/04/14 File: Z/loans/loanforms/ALDloanapp
IMPORTANT
DATA PROTECTION STATEMENT
(Use of your personal data by New Central Credit Union Ltd. and Credit Reference and Fraud Prevention Agencies)
Data Protection Statement: We may use credit reference (CRA) and fraud prevention agencies (FPA) to help us make decisions. A condensed guide to how we will use your information is detailed below. If you would like to read full details of how your data may be used, please call us on 024 7663 3456 and we will send you a leaflet. By confirming your agreement to proceed you are accepting that we may each use your information in this way (please see formal declaration on the loan application)
How we will use your data:
1. When you apply to us to open an account, this organisation will check our own records, and search at credit reference and fraud prevention agencies for information on all applicants and their financial associates. CRAs supply to us both public (including the electoral register) and shared credit and fraud prevention information.
If you are providing information about others, on a joint application, we will link your records together, so you must be sure that you have their agreement to disclose information about them. CRAs also link your records together and these links will remain on your and their files until such time as you or your partner successfully files for a disassociation with the CRAs to break that link. If you give us false or inaccurate information and we identify fraud, we will record this and may also pass this information to FPAs and other organisations involved in crime andfraud prevention.
2. We will use the information provided to use by credit reference and fraud prevention agencies to help make credit or credit related decisions about all applicants to verify their identity, for the prevention and detection of fraud and/or money laundering, and to manage accounts. If you borrow from us and do not make payments that you owe us, we will trace your whereabouts and recover debts.
3. When credit reference agencies receive a search from us they will place a search “footprint” on your credit file that may be seen by other lenders whether or not this application proceeds.
4. Where you borrow from us, we will give details of your accounts and how you manage it/them to CRAs. If you borrow and do not repay in full and on time, CRAs will record the outstanding debt. The information which we and other organisations provide to the credit reference and fraud prevention agencies may be supplied by credit reference agencies to other organisations and used by them to perform similar checks. Records remain on file for 6 years after they are closed, whether settled by you or defaulted.
5. We and other organisations may access and use from other countries the information recorded by fraud prevention agencies.
6. Your data may be used for other purposes for which you give your specific permission or, in very limited circumstances, when required by law or where permitted under the terms of the Data Protection Act 1998.
You can contact the CRAs currently operating in the UK; the information they hold may not be the same so it is worth contacting them all. They will charge you a small statutory fee.
Experian, Consumer Help Service, PO Box 8000, Nottingham NG80 7WF or call 0844 4818000 or log on to
Call Credit, Consumer Services Team, PO Box 491, Leeds, LS3 1WZ or call 0870 0601414
Equifax PLC, Credit File Advice Centre, PO Box 3001, Bradford, BD1 5US or call 0870 0100583 or log on to