Loan Application Form

1Personal Info

2Security Info

3Employment Info

4Additional Info

5List of Assets

6References

7Credit Obligations

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Date*
MM slash DD slash YYYY
Preferred Branch*
Select the branch of choice or the one nearest you
Date of Membership
MM slash DD slash YYYY
TAX Registration Number (TRN)*
Name*
First Last
Your full name
Date of Birth*
MM slash DD slash YYYY
Home Address*
Street Address Address Line 2 City State / Province / Parish Country
Any previous Address?*
- Yes
- No
Previous Address*
Street Address Address Line 2 City State / Province / Parish Country
Phone
Email
Cash Required (Words and Figures)
$*
I desire this loan for the following provident or productive purposes

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I offer as security-:
Shares
Deposits
Other

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Employment information
Company Name*
First
Address
Street Address Address Line 2 City State / Province / Parish Country
How Long

Duration of employment
Phone
Salary
Other Income
Income Source of Funds

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List
Dependents-relation Age
Name of Wife/Husband
First Last
Employed By
Company Name
Company Address
Street Address Address Line 2 City State / Province / Parish Country
How Long
DD slash MM slash YYYY

Choose start date
Salary
Next of KIN information
In case of an emergency, who should we contact
Relative*
Firstname Lastname Relation Contact Number
Home Address
Street Address Address Line 2 City State / Province / Parish Country
Company Address
Street Address Address Line 2 City State / Province / Parish Country

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Listing of Assets
Real Estate Information
Location of Property
Street Address Address Line 2 City State / Province / Parish Country
Ownership
- Mortgage Property
- Own Property (no Mortgage)
- Rent
Valuation
Valuator
Amount of Mortgage
Mortgage Holder
Monthly payment
Monthly Rental
Listing of Assets
Auto Mobile if any
Automobile Info
Make Model Year Estimated Value

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References*
Full Name Address Telephone

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CREDIT OBLIGATIONS
INCLUDING HIRE PURCHASE (List AllDebts)
List of Debts
Name of Creditor Address Monthly Payments Balance Owing

Including hire purchases
Consent*
I agree to the privacy policy.
I hereby agree to comply with all the terms, conditions, rules and regulations of the Credit Union now in force or which may hereafter be adopted. I am not indebted to any other Credit Union, Bank, or loan Agency, either as a borrower or co-maker other than stated on Loan Application dated the
day of {date_created} In the event of termination of my employment with the Company of my employment stated on the said Application, hereby authorize the said Company to deduct from any monies owing to me by the said Company in respect of wages, salary, pension or superannuation funds or any other monies of whatever nature at the time of termination of my employment, and to pay to City of Kingston Cooperative Credit Union Limited from such monies all amounts then due by me to them, inclusive of interest to settle any outstanding loan. The statements herein are made for the purpose of obtaining the loan and are to the best of my knowledge and belief true.
COK SODALITY CO-OPERATIVE CREDIT UNION LTD.

Invest in your future today!
Dated: 23/09/2021
To: The Credit Bureau* Re: Disclosure of my Credit Information I {Name (First):6.3} {Name (Last):6.6} of in the parish of {Home Address (State / Province):8.4} with Tax Registration Number {TAX Registration Number (TRN):78} hereby consent:
1. to The Credit Bureau* disclosing to COK Sodality Co-Operative Credit Union such credit information which it may have in regard to me.
2. to COK Sodality Co-Operative Credit Union disclosing to any credit bureau duly licensed under the Credit Reporting Act any and all credit information which it may receive in regard to me pursuant to this consent, in so far as this is required by law;
3. to COK Sodality Co-Operative Credit Union providing this signed consent form to The Credit Bureau* (pursuant to item 3) by electronic means;
I understand and agree that my consent is hereby given:
- i. shall subsist for the duration of my application for this or any future credit facility that I may have or apply for with COK Sodality Co-Operative Credit Union and for so long as this credit facility or such future credit facility shall subsist;
- ii. shall remain valid and binding until it is expressly revoked by me;
- iii. cannot be revoked during the subsistence of any credit facility that I may have with COK Sodality Co-Operative Credit Union but only upon or after the termination of such facility;
- iv. will be applicable to all applications that I may make to obtain a credit facility from COK Sodality Co-Operative Credit Union where I am involved in that application either as the borrower or surety/guarantor and also for the purpose of facilitating risk assessment for granting further extension of credit by COK Sodality Co-Operative Credit Union in relation to any credit facility currently existing or which may come into existence in the future. , hereby sign this Consent of Natural Person of my own free will and volition the same having been read by/to me and fully understood.
* Any Licensed Credit Bureau within Jamaica **Signature may be witnessed by either an officer employed to COK Sodality Co-Operative Credit Union, Credit Union Manager, an Attorney-at-Law, Justice of the Peace and/or by verification methods consistent with the Electronic Transactions Act. Revised July 2013
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I offer as security-:

Employment information

Next of KIN information

Listing of Assets

Listing of Assets

CREDIT OBLIGATIONS

COK SODALITY CO-OPERATIVE CREDIT UNION LTD.

Invest in your future today!

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Income	Source of Funds

Dependents-relation	Age

Firstname	Lastname	Relation	Contact Number

Make	Model	Year	Estimated Value