Loan Application Online – Essential and Emergency Services & Partners Co-operative Credit Union

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Personal Information

Full Name

Date of Birth

Account #

Telephone #

Email Address

Home Address

Loan Amount Required

Loan Period (months)

Amount In Words

Loan Type

Purpose for Loan

Number of Dependents

Age of Dependents

Emergency Contact Name

Emergency Contact Address

Emergency Contact Number

Employment Information

Employer

Address

Line 1

Line 2

Gross Monthly Income

Less Deductions At Source

Net Income (Take Home Pay)

Total Income

Less Total Expense

Income / Deficit

Monthly Expenses

Rent/Mortage

Hire Purchase

Motor Vehicle

Home Insurance

Transportation

Utilities

Education

Medical

Living Expenses

Entertainment

Total Expenses

Required Documents

National Id (Front)

National Id (Back)

Tax Registration Number Card (Front)

Tax Registration Number Card (Back)

Pay Slip

Member's Declaration

I hereby confirm that the information given is true in all respects, accurate and complete and that I have not withheld any information that might affect the Credit Union’s decision. I am agreeable to the Credit Union taking such steps as deem necessary to verify any of the information given. The Credit Union is authorized to charge my account with the monthly payments on due dates and I agree to pay all appropriate charges for any overdue instalments. The Credit Union is authorized to provide information to credit bureaus and other credit grantors as permitted by law and to send me information about other services. I agree to pay all fees associated with the processing of this loan (adapted from JCCUL).

By checking this box, I agree to the above terms and conditions.