Loan Application Form

1 Personal Info

2 Security Info

3 Employment Info

4 Additional Info

5 List of Assets

6 References

7 Credit Obligations

Date*
Date Format: MM slash DD slash YYYY
Preferred Branch*
Select the branch of choice or the one nearest you
Date of Membership
Date Format: MM slash DD slash YYYY
Name*
First Last
Your full name
Date of Birth*
Date Format: 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

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
Date Format: 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

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

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_____________ 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.
Please download and fill out the Credit Bureau Consent form and reupload it. Download Credit Bureau Form Now
Please download, complete and re-upload Credit Bureau Consent form*
Accepted file types: jpg, gif, png, pdf.
Please download and fill out the Credit Bureau Consent form and reupload it. Download Credit Bureau Form Now

I offer as security-:

Income	Source of Funds

Dependents-relation	Age

Firstname	Lastname	Relation	Contact Number

Make	Model	Year	Estimated Value