LOAN APPLICATION FORM

Please fill fields highlighted in red and submit.

Cash required
$

Present Loan Balance
$

Total Loan
$

Account No

Loan Type/Code

Date

Mrs.Mr.Miss

Home Address

Tel

Email

I hereby apply for loan of
$
for a period of Months
to be repaid in weeklyfortnightlymonthly payments
of $

I desire this loan for the following provident or productive purpose(s):

I offer as Security:
Shares $
O/D $
T/D $
G/H 1 $
G/H 2 $
G/H 3 $
Co-makers
Titles
M/V
Other

PERSONAL INFORMATION

Date of Birth

No. of Dependents

Name of Wife or Husband

Name, Address & Telephone Number of
nearest Relative (Exclusive of wife or husband)

INCOME INFORMATION

Employed by

How long

School

Tel

Position

Monthly/Weekly Salary
$

Other Income
$

If Wife or Husband employed, state
Employed by

How long

Tel

Monthly/Weekly Salary
$

CREDIT OBLIGATIONS INCLUDE HIRE PURCHASE (list all debts using and attaching an additional sheet if necessary).

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

TRN #

Transfer
$
to Easi Access Savings G/L#
Date
Signature

Amount
$

Cheque No

Date

Amount
$

Cheque No

Date

Amount
$

Cheque No

Date

Amount
$

Cheque No

Date