Present Loan Balance
I hereby apply for a total loan of
for a period of Months
to be repaid in weeklyfortnightlymonthly payments
I desire this loan for the following provident or productive purpose(s):
I offer as Security: Shares $
Date of Birth
Name of Wife or Husband
Name and Address & Telephone Number of
Nearest Relative (Exclusive of wife or husband)
I hereby agree to comply with all the terms, rules and regulations of the Credit Union now in force or which may hereafter be adopted. The statements herein are made for the purpose of obtaining the loan and are true to the best of my knowledge and belief.
Signature of Applicant
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