If you are a human and are seeing this field, please leave it blank. Fields marked with an * are required For Members Only Become a member? Loan Details Amount requested £ Repayment period weeksfortnightmonths Purpose of Loan Amount of Savings to be left throughout period of Loan Member Details Name * Membership No * Become a member? Address 1 Address 2 Post Code * Phone Mobile Email Date of Birth * Time at Present Address If less than 3yrs please give previous address No. of Dependent Children Partner's Name Household make-up Applicant Only Couple with no Children Couple + Children Lone Parent Household Status Owner Occupied Private Rented L.A RentedH.Ass RentedFamily or Friends Employment Status Unemployed Employed FT Employed PT Student RetiredSelf-employed Name of Employer Tel No Time with Employer Address of Employer Works I.D. No How Paid? Direct to Bank Cash When are you paid? Weekly fortnightlyMonthly Bank Details - Name Sort Code Account No Have you got any Bad Debts or CCJs? YesNo If yes - Give Details Have you got a Social Loan? YesNo If you are a human and are seeing this field, please leave it blank. SPENDING PRIORITY PAYMENTS Monthly Rent / Mortgage Council Tax Electricity Gas Water T/V Licence House, Contents & Life Insurance HOUSEHOLD & EVERYDAY Food Toiletries & Cleaning etc. Childminder / Child Care School Lunches Telephones - Landline & Mobile Satellite / Cable Bus Fares & Car Expenses Social (Alcohol, Cigarettes etc) Clothes etc. FINANCIAL PAYMENTS Bank Loans Credit Cards & Store Cards Doorstep Collections Hire Purchase / Rentals Catalogues Maintenance (Paid Out) Bad Debts / Other Payments TOTAL SPENDING INCOME WAGES Monthly Self Partner / Spouse State Pension Pension Credit BENEFITS (Specify) Add total below Total BENEFITS Occupational Pension OTHER Income Maintenance (Received) Family Board Other TOTAL INCOME less TOTAL SPENDING If you are a human and are seeing this field, please leave it blank. SURPLUS INCOME Declaration and Agreement Data Protection Statement: in accordance with the principles of the Data Protection Act 1998, I understand that Adventist Credit Union will use my personal details for the purposes of managing my accounts with the credit union. My information will be treated as confidential and only disclosed a) at my request, b) to Adventist Credit Union's agents in managing my accounts, c) in the public interest, d) to prevent fraud or by order of the Courts. I also understand that, for a fee, I am entitled to a copy of the information held about me by applying in writing. Important - Your Personal Information; Adventist Credit Union may use credit reference and fraud prevention agencies to help us make decisions. A short guide to 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 condensed 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. Statement of Insurability: I declare that to the best of my knowledge and belief, I do not have a life threatening condition. I understand that making a false declaration may affect any insurance claim. Declaration * I declare that the information I have given on this form (including the reverse) 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. I authorise ACU to make any credit reference or other enquiries in accordance with their normal procedures in connection with this application. I agree that if I default on repayments, information about my loan may be passed on to the Department for Work and Pensions for their consideration of deductions from the benefits that I am or will become entitled to. AgreeDisagree Confirm that you are not a bot *
