Loan Application Form

Transcription

1 Membership Number... Loan Number... Personal Details Title Mr Mrs Ms Miss Other (please specify) Surname Previous Name(s) Loan Application Form To be completed in BLOCK CAPITALS and returned to: Customer Services NELCU Municipal Office Town Hall Square Grimsby North East Lincolnshire DN31 1HU Tel Forename(s) Middle Name(s) of Birth Age National Insurance No. Home Address Post Code Time at Current address Telephone No. Landline/Mobile Area of Town i.e. West Marsh If less than 3 years please provide details of previous addresses in the past 5 years below. A phone number must be included Residential Status Owner Mortgaged Property Tenant Housing Association Tenant with Private Landlord With Family / Friends No Fixed Abode No. In Household No. of Adults No. of Children under 5 No. of Children over 5 Marital Status Married / Living with Partner Divorced Separated Widowed Single Address Previous Addresses Postcode Postcode Postcode Time at Address Time at Address Time at Address Are you an current CU member? YES NO Are you a new borrower? YES NO Have you been a CU member? YES NO Membership Number How did you hear about the Credit Union? Do you consider yourself to be disabled or have a long term illness? YES NO If so, please give details Page 1 of 6

2 Do you receive any DWP benefits or HMRC Tax Credits? YES NO Benefit type How much Paid Weekly/ Fortnightly/Monthly If necessary please continue in Other Information Credit History Details (previous bad credit history may not necessarily count against you) Who else do you owe money to? Please list all Loans, Mortgages, Car Finance, HP, Credit/Store Cards, Catalogue, Doorstep/Payday Lenders etc Start date Name of Bank/Agency/loan/Company Original amount Repayment amount and term balance If necessary please continue in Other Information Have you ever been declared bankrupt? If Yes please give details : YES NO Do you have any CCJs against you? (Failure to provide this information will result in the loan being refused ) Name of company or person Original amount Repayment amount/term YES NO balance Brief details of circumstances: Name of company or person Original amount Repayment amount/term balance Brief details of circumstances: Name of company or person Original amount Repayment amount/term balance Brief details of circumstances: If necessary please continue in Other Information Employment Details Employment Status Employed Self Employed Retired Unemployed Full Time Part Time Incapacity Student Other Employer s Name Employer s Telephone No. Employer s address Post code Occupation Time with Employer Page 2 of 6

3 Income & Expenditure Details - Please include all household income & expenditure Per Month - M Per Month INCOME Week - W Week Salary/wages Applicant Universal Credit Salary/wages Partner s Pension Child Tax Credit Working Tax Credit Child Benefit Housing Benefit Council Tax Benefit Incapacity Income support Other income (please specify) ESA JSA DLA /PIP Total (A) Per Month - M Per Month OUTGOINGS Week - W Week Rent / Mortgage Bank Loan Council Tax Bank Overdrafts Electricity / Gas / Heating Oil Catalogues Water Credit / Store Cards Telephone / Mobile Car Loan TV / SKY / Digital incl. Licence Hire Purchase Broadband / Internet Payday Loans Housekeeping Other Loans e.g. doorstep (e.g. food, toiletries, nappies, lenders, moneyline drinks, magazines) Clothing Car Insurance Smoking Breakdown cover Pets e.g. food, vet bills & insurance Petrol Home Insurance Travel & Public Transport School & Nursery Costs, incl. school dinners & uniform Social Expenses e.g. memberships, subscriptions Life Assurance Pensions Other Outgoings(please specify) Savings & Investments Total (B) - M - W - M - W Total available Income A-B This is a true and accurate statement of my finances. Signed: Page 3 of 6

4 Loan Details Purpose of loan How much do you wish to borrow? Repayment amount Weekly * Fortnightly* Monthly* Repayments Method Standing Order * Benefits* What date in the month will you make your repayment? (Standing Order/Payroll only) Payroll Deduction * Other (Agreed by CU) * * Tick as appropriate How would you prefer the loan paid out to you? BACS Payment Sort Code Bank account no Prepaid Card Load Cheque Made Out for Cash Cheque Payable to: Name For Starter Loan Applicants If this application is successful the Credit Union requires that before receiving the loan at least one type of benefit must be paid through the Credit Union. Loans will be paid out only after the benefit payment is received. Type of benefit Please pay the outstanding amount of my benefit into Reference My nominated Bank account Sort Code Account no My CU savings account Personal Details of Contact Person (not at the same address) Title Mr Mrs Ms Miss Other (please specify) Surname Forename(s) Home Address Post Code This person s relationship to you Home Telephone No. (inc STD) Mobile Telephone No. I hereby give North East Lincolnshire Credit Union permission to contact the above person in the event that the Credit Union lose contact with me Signed. Page 4 of 6

5 Data Protection Statement In accordance with the principles of the Data Protection Act 1998, we will use your personal details for the purposes of managing your accounts with the credit union. Your personal details will be treated confidentially and will only be shared with other agencies for the purposes of credit referencing and debt recovery. We may at times use your details to keep you informed of services available from the credit union. If you wish your details to be used for these marketing purposes, please tick this box. Partner s Declaration If you have declared your partner s income details as part of your overall income for this loan, your partner will need to sign below confirming agreement of their information to be used in considering the loan and its repayment. Signed Print Name Formal Declaration I declare that the information I have given on this form is, to the best of my knowledge and belief, accurate and full information. 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. Signed Print Name Other Information North East Lincolnshire Credit Union Ltd is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Also a member of the Financial Services Compensation Scheme, the Financial Ombudsman Service and ABCUL. FSA Reg No: Reg No: 604C Registered Office: Ground Floor, St James house, St James Square Grimsby DN31 1EP Page 5 of 6

6 Action Tracker/Credit Checks For Official Use Only Received by: Documents Received Comments: Received: Proof of ID Proof of Address Income Bank Statements N I no Other please state Decision : Reason: Approved / Refused / Referred Term of loan Weeks / Months / Years member informed: Authorised by: Print name: Input to curtains by : North East Lincolnshire Credit Union Ltd is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Also a member of the Financial Services Compensation Scheme, the Financial Ombudsman Service and ABCUL. FSA Reg No: Reg No: 604C Registered Office: Ground Floor, St James house, St James Square Grimsby DN31 1EP Page 6 of 6