APPLICATION FOR LOAN WITHIN SHARES

Cash Required:*

Account No:

Loan Type/Code:

Date:*

Title:

Name:*

TRN:*

Home Address:*

Phone:*

I hereby apply for loan of $ for a period of ___ months to be paid in MonthlyFortnightlyWeekly payments
of $_________. At an interest rate of 6.75% per annum. I desire this loan for the following provident or productive purposes:*-

I offer as security: Shares $
I have read and hereby agree to comply with all the terms, conditions, rules and regulations of the credit union now in force or which may hereafter be adopted. The statements made herein are true and are made for the purpose of obtaining the loan.

Amount $:

Cheque No:

Date:

PERSONAL INFORMATION

Date of Birth:*

No. of Dependents:*

Email Address:*

Name of Wife or Husband:

Phone:

Name of Nearest Relative (Excluding Wife or Husband):

Relationship:

Address of Nearest Relative (Excluding Wife or Husband):

Phone:

INCOME INFORMATION

Employed By:*

How Long:*

Phone:*

School:*

Job Title/Position:*

Salary:

Amount $:

Other Income $:

Valid Government-issued photo ID (Driver’s License, Passport or Voter’s ID):*

TRN Card:

Pay slip #1 (not older than two months):*

Pay slip #2 (not older than two months):*