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Online Loan Application



Please complete all your details in the form below, and click submit when you have finished.

Online Loan Application
* Required Fields
Title: *
Full name: *
Address: *
National Insurance number: *
Length of Time at address
(In Years and Months):
*
Previous Address (If less than 3 years):
Length of Time at previous address
(In Years and Months):
Previous Address:
Length of Time at address:
Type of Accommodation: *
If Other, please specify:
Tel contact: *
Alternative number:
E-mail Address: *
Date of Birth: *
Marital Status: *
Number of Adults in the Household: *
Number of Dependants over 14:
Number of Dependants under 14:
Employment Details
* Required Fields
Employer:
Work Address:
Occupation:
Length of Service:
If unemployed please state your main benefit:
Main Income:£ *
How often do you receive it?
Other Income:£
How often do you receive it?
Current Financial Situation
* Required Fields
I declare that I am indebted to the following:
»
Original AmountBalance OutstandingMonthly Repayment Amount
Bank/Building Society:
£ £ £
Rent/Mortgage:
£ £ £
Credit Card:
£ £ £
Other:
£ £ £
Expenditure
* Required Fields
Weekly Expenditure
Housing costs eg rent, electric: *
TV, Phone, Internet costs: *
Living expenses e.g. food, clothes: *
Travel costs e.g. car expenses, bus: *
Finance costs e.g. loans, insurance, fines: *
Leisure costs e.g. going out, hobbies: *
Dependants expenses e.g. childcare, maintenance, pets: *
Annual expenses e.g. christmas, birthdays, holidays: *
Have you applied for a Loan previously? *
If Yes, please state when:
Current Loan Balance(s):£
Current Arrears:£
Loan Details
* Required Fields
Type of Loan:
I wish to apply for a loan of:£ *
Purpose of Loan: *
Date Required: *
To be repaid every: *
In installments of:£ *
Declaration
* Required Fields
I declare that I am not indebted to any other Credit Union, Bank or Loan Agency either as a borrower or Guarantor, except as stated on this application. The statements herein are made for the purposes of obtaining the loan and are true to the best of my knowlewdge and belief.
I declare that to the best of my knowledge: *I am in good health
I am NOT in good health
And that: *I am fit to follow my normal occupation
I am NOT fit to follow my normal occupation
Important - Your Personal Information
We may use credit reference and fraud prevention agencies to help us make decisions. What we do and how both we and credit reference and fraud prevention agencies will use your information is detailed in the leaflet called:
A Guide to the use of your personal information by ourselves and at Credit Reference and Fraud Prevention Agencies.
By confirming your agreement to proceed you are accepting that we may each use your information in this way.
Date: *
Data Protection Act 1988 - I consent to the information contained in this application form being used by the Credit Union for the purposes of processing my application
Verification
* Required Fields
Please enter the code shown:
*
Helps prevent automated form submissions.
More Info
 
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2Shires Credit Union Tel: 01909 500575 Email: info@2shires.org.uk Web: http://www.2shires.org.uk
Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority
FCA & PRA FRN: 213893