Athlone Credit Union

Services Online Loan Application

ONLINE APPLICATIONS ARE LIMITED TO A TOTAL LOAN BALANCE OF 2,000. ANY APPLICATION ABOVE THIS AMOUNT MUST BE MADE IN PERSON AT EITHER OFFICE.

TO ASSESS THE LOAN, ALL APPLICATIONS MUST BE ACCOMPANIED BY RELEVANT DOCUMENTATION IE. TWO RECENT PAYSLIPS, UP TO DATE BANK STATEMENTS FOR THE LAST TWO MONTHS AND PHOTO ID

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

Online Loan Application

* Required Fields

Account Number:

Member Name:

Member Address:

Previous Address (If less than 3 years):

Type of Accommodation:

If Other, please specify:

Tel Home:

Tel Work:

E-mail Address:

Date of Birth:

Marital Status:

Number of Dependants:

Employer:

Work Address:

Occupation:

Length of Service:

Weekly Salary:

€ *

Other Income:

€

Payroll Number:

Spouse/Partners Name:

Spouse/Partners Employer:

Employers Address:

Spouse/Partners Occupation:

Spouse/Partners Weekly Income:

€

Any Other Income:

€

Spouse/Partners Date of Birth:

I declare that I am indebted to the following:

Original Amount

Balance Outstanding

Monthly Repayment Amount

Bank/Building Society:

€

Rent/Mortgage:

€

Credit Card:

€

Other:

€

Previous Credit Union Loans

Amount

Date

Repayment Amounts

Repayment Frequency

Current Share Balance:

€ *

Current Deposit Balance:

€

Current Loan Balance:

€

Current Arrears:

€

I wish to apply for a loan of:

€ *

Pupose of Loan:

Date Required:

To be repaid every:

In instalments of:

€ *

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

Signature of Applicant:

Date Signed:

Name of Guarantor (if required):

Guarantors relationship to Applicant:

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

Credit Rating

* Required Fields
I agree to the Credit Union conducting an Irish Credit Bureau ( I.C.B.) check as part of this on-line loan application process: *	I Agree
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