AuthorisedbythePRA& Regulatedby the FCAFirm No214295

CARLOANAPPLICATIONFORM

PleasecompleteALLsectionsof theform inBLOCKCAPITALS.

Ifyouneedanyhelpincompletingtheform,stafforvolunteersinthecreditunionwill bepleasedtoassist.

PLEASENOTETHISFORM ISANAPPLICATIONFOR A LOANNOTA GUARANTEETHATALOANWILLBEGRANTED

  • SUPPORTINGDOCUMENTS

2MostRecentPayslips

1MonthUpToDateBankStatement

If you are going to claim Income from Lodger/Other Residence,State/ Occupational Pension, Maintenance/CSA, Child Benef., Child/WorkingTax Credit, Incapacity Benefit, DLA/Carers Allowance or Housing Ben., up-to- date documents need to be provided along with the loan application form.

To enableyourapplication to beconsidered, pleaseensureyou haveenclosed therelevant documentslistedabove.

MEMBERDETAILS:*Pleasecompleteloanapplicationformandloanagreementformfully

Name…………………………………..……...... Membership number……………Payroll No:…………..

Address……………………………………………………………………………………………………......

……………………………………………………..Postcode……………………………………….

Doyou:OwnyourownhomeRentfromtheCouncilRentPrivatelyRent/PartownfromHousingAssoc.

Livewithparents

Time at currentaddress…………………(Iflessthan3years,please providedetailsofotheraddressesinthe past3years)

………………………………………………………………………………………………………………………………

Dateof birth…………………NationalInsurance number:HomeTelNo_E-mail Address……………………………………...... Mobile number…………………………......

EMPLOYMENT/BENEFITDETAILS

Employmentstatus* / employed / self-employed / unemployed / retired
Nameofemployer…………………………………………...... ContractedFulltimePart time
Address of employer………………………………………………………………………………..Workphonenumber…………………………..Can youbecontactedhere? Yes No
No.of yearswithcurrentemployer…………..DateEmployed………………(Iflessthanoneyear,pleaseprovidedetailsof
Previous employment)……………………………………………………………………………………………………………

LOANDETAILS

Purposeofloan:......

ALOANWILLNOTBECONSIDEREDUNLESSIDDOCUMENTATIONCONFIRMINGPROOFOFIDENTITYANDPROOFOFADDRESSHASBEENPRESENTEDTOTHECREDITUNIONOFFICE.

Amountrequested ………………..Repaymentperiod………………….(MONTHS/YEARS)

Maximum lending (Up to£5,000) Repaymentperiod upto 36Months

IFAPPLICATIONISSUCCESSFULHOWWOULDYOULIKETORECEIVEYOURMONEY

PleasespecifyONEof thefollowing

CashchequeChequethroughthepost:Pleaseindicatepayeename(s)......

Directlyintoabankaccount

NameofBank…………………………….……………..A/cName………………………......

A/c Number:Sort Code--(COMPULSORY)

BankAddress: ……………………………………………………………………………...... (COMPULSORY)PLEASECOMPLETE THEBORROWER’SDETAILON THELOANAGREEMENTFORM i .e YOURNAME ANDADDRESSAS WELLAS SIGNINGTHE SIGNATURESSECTION INORDER TO RECEIVEYOUR LOAN CHEQUE OR MONEY TRANSFERREDINTOYOURBANKACCOUNT. (COMPULSORY)

DataProtectionStatement:Inaccordancewiththeprinciples oftheDataProtectionAct1998, wewill useyourpersonal detailsforthepurposesofmanagingyouraccountswiththecreditunion.Yourpersonal detailswillbe treatedconfidentiallyandwillonlybe sharedwithotheragenciesforthepurposes of creditreferencinganddebtrecovery,forwhichpurposeweholda CategoryFconsumercreditlicence.

ABOUTYOURFINANCEPlease,include allhouseholdincome and expenditure,plusbalancesofotherborrowings.
*ProofneedstobeprovidedPleasespecifymonthlyamountPleasespecifymonthlyamountandwhois responsibleforpayment
Income / MONTHLY
£ / HouseholdExpenditure / MEMBER
£ / PARTNER
£
Salary/wages / Rent/mortgage
Salary/wages(Partner) / ServiceCharges
Mortgageendowment/paymentprotection
Income fromLodger/otherresidence* / Council tax
State/Occupational Pension* / HomeTelephone
ChildBenefits* / MobilePhone
Maintenance/CSA* / Internet
Child/WorkingTax Credit* / Electricity
IncapacityBenefit/ESA* / Gas
DLA/PIP* / Watersewage
CarersAllowance* / TVLicence
HousingBenefits* / TVRentals/Sky/Cable
TotalIncome / TravelExpense:/Petrol /Busfares
OtherLoans / MonthlyRepayment / BalanceOwing / RoadTax
OtherCreditUnionLoans / MOT/Service
CreditCardRepayment / ChildCare
HirePurchaseRepayment / CarInsurance
Catalogue/MailOrderRepayment / Maintenance/CSA
Bank Loan/CarRepayment / HomeInsurance (Building/contents)
OtherLoanRepaymente.g.(HomeCreditCompany / MonthlyShopping(food Toiletries)
LifeInsurance
CourtOrders / Clothing/Hair
PaydayLoans / Social
Anyotherloans / Other(pleasespecify)
Totalof Other Loans / TOTALEXPENDITURE
FORMALDECLARATION
Ideclarethat:(Pleaseread carefullybeforesigning.Askif anypart isnot clear)
1)Iamamnot*ingood healthandthat,I dodonot*requireregularmedicaltreatment.(*Ifyouarenotingoodhealth,pleasecompletethecreditunionmedicalformforinsurancepurposes)
2)Iamnotindebtedtoanyothercreditunion,bank orloanagency,eitherasaborrowerorguarantor,exceptasstatedabove
3)Iagreetopermitthecredituniontocarryoutacreditbureaucheck onmyselfiftheydeemitnecessary(NBAnegativereportwillnotnecessarilyeffect yourloanapplication)
4)IunderstandthatIwillberequiredtomaintaintheminimum savingslevel,underthisloanagreement,of£30.00
5)Ihavereadandunderstoodthedataprotectionstatementregardingdatasharingandagreetoinformationbeingsharedfornon-commercialprojectpurpose
6)IdonothaveanyCCJs(CountyCourtJudgements)[IfyoudohaveaCCJthiswillnotgoagainstyouwhenweassessyourapplication]
7)Ihavenotbeenbankruptinthelast5 years(ifyouhavepleaseletusknow)
8)Iamnotcurrentlyanunderchargedbankrupt
I declarethat theinformation I havegiven onthisformis, to thebestof myknowledgeandbelief, accurateand fullinformation. I understand that theprovision of falseinformation isfraudand thecredit union maytakeappropriateaction ifI amfoundto havedeliberatelyprovided falseor misleadinginformation.
Applicant’s signature…………………………...... Date……………………………….
Ifyouhavedeclaredyourpartner’sincomedetailsaspartofyouroverallincomeinapplyingforthisloan,your partnerwillneedtosignbelowconfirmingagreementfortheirinformationtobeusedinconsideringtheloanand itsrepayments.
Partner’s Signature: ...... Name...... Date......
(Pleasenotethatthisapplicationformwill notbeprocessedwithoutyour signatures)
OFFICIALUSEONLY:-Datereceived……………….ShareBalance:£………………. LoanBalance:£……………DepositMethod:StandingOrder/ PayrollDate ofLastLoan:Amount:£………………Date of LastDeposit…………………………….
Approved/ Refused / Referred:APPROVEDBY:Name………………………………………….Signature……………………………….Date…………………………………Name………………………………………….Signature……………………………….Date…………………………………
Name………………………………………….Signature……………………………….Date…………………………………

AuthorisedbythePRA andRegulatedby theFCAFirmNo214295

LOANAGREEMENT

Pleasecompletetheborrower’sandsignaturesectionofthisforminordertoreceiveyourchequeortopaymoneyintoyourbankaccount;fundscannotbereleaseduntilthisformissignedbyyou.(Compulsory)

LENDER’SDETAILS(“THELENDER”)

Thelenderisa CreditUnionregisteredunder theCreditUnionsAct1979whichgovernstheoperationofthisagreement

Name: LEWISHAMEMPLOYEESCREDITUNIONLtd

Operationaladdress:6 BROWNHILL ROAD, CATFORD, LONDON SE6 2EJ

RegisteredAddress:LEWISHAMTOWNHALL,CATFORD,LONDONSE64RU

BORROWER’S DETAILS(“THEBORROWER”)

Name…………………………………………...Membershipnumber…………………..Address………………………………………………………………………………………

…………………………………………………Postcode…………………………………

LoanNumber:…………………………

ThirdPartyPermission

Bysubmittingthis applicationform,youwill be indicatingyourconsent to receivingproduct andservice informationbyletter,phoneor e-mailfrom us and our partnersunlessyouhave

indicatedanobjection toreceivingsuch information bytickingtheabovebox.

(INTERESTONLOANSARECHARGED ON THEREDUCING BALANCE)

LOANDETAILS

Theamountborrowedunder thisloanagreement is£

TheTOTALAMOUNTOWING (“theLoan”) is:£

Themonthlyrate ofinterestis0.9 %%

TheANNUALPERCENTAGERATE(APR) is10.5 % %

Theloanwillberepaidby thisnumberof

weekly/monthly*repayments©

Theamountofthe weekly/monthlyrepayment willbe:£(D)

TOTALAMOUNT PAYABLE(includinginterest)(seeterm 6)£(©xD)

Increased interest rates - (after 2 months with no log book)

£

26.8%2% per month

TERMS OF THEAGREEMENT:-

1.TheLenderwilllendandtheBorroweracknowledgesthattheyhavereceived,thesumborrowedunderthisagreement.TheBorrowerwillrepaytheLoan(i.e.theTotalAmountOwing)bytherepaymentssetoutintheloandetailsabove,includingInterestchargeddailyontheunpaidbalanceoftheloanandanyunpaidinterestataratenotexceeding0.90%permonth,thatisanANNUALPERCENTAGERATE(APR)of10.5%

2.TheBorrowerhastherighttosettletheAgreementearlyatanytimebypayinginfullthebalanceoftheLoanandanyunpaidinterestoutstanding. TheLenderwill,onrequest,providetheBorrower

withawrittenstatementofthesumswhichhavebeenpaidandwhichremainoutstandingundertheagreement

3.TheBorroweracknowledgesthatthedetailsgivenontheLoanApplicationforthisagreementarecorrectandwillinformtheLenderimmediatelyofanychangeinfinancialcircumstances,whichmayreducetheirabilitytorepaytheLoan,orofanychangeintheiraddress

4.IftheBorrowerfailstopayanyamountduetotheLenderunderthisagreement,orbreachesanyofitsterms,theLenderhastherighttodemandearlyrepaymentofallorpartofthebalanceoftheLoanoutstanding,togetherwithanyunpaidinterest.TheLenderwillgivetheBorrowerwrittennoticenotlessthansevendaysbeforetakinganyactiontorecoveranysuchsum. TheBorroweracknowledgesthat,ifanyloanrepaymentsarenotpaid,orarenotpaidaftertheagreedtime,thismayresultintheTotalAmountPayableundertheAgreementbeinggreaterthanthesumsetoutintheLoandetails

5.Intheeventatanytimetheloanfallmorethanthreemonthsinarrearstheloanshallbeindefault.Thewholeoftheloanplusinterestwillbecomeimmediatelyrepayableandthelenderwillbeentitledtoapplythevalueoftheborrower’ssharestotheoutstandingloanbalanceandanyunpaidinterest

6.TheBorrowerwillbeliableforanycoststheLenderincursinrecoveringsumsdueundertheAgreement

7.TheBorroweratthetimeofsigningthisagreementisnotinpositionofanyinformationregardingthestatusofhis/heremploymentthatwouldendangertherepaymentoftheloan

8.Theborroweragreestosaveaminimumof£30.00permonthwhilstthisloanisinforce

9.TheBorroweragreestosubmitNEWCARCHANGEOFOWNERSHIPLOGBOOKasproofofpurchasewithintwomonthsofdepositoffundsintobankaccountortheloanrevertstoanannualpercentageof26.8%APRor2%permonth

10.TheBorroweragreestoassigntothelenderallpaidshareandpaymentsonaccountofshareswhichtheborrowerhasormayhaveinfutureinthecreditunionassecurityforpaymentoftheloanandforinterestorexpenseswhichmaybecomedueandtheBorrowerauthorisesthecredituniontosetofforapplyanyorallsuchsharestowardspaymentoftheloan,interestorexpensesowedbytheborrower

SIGNATURES

ThisisalegallybindingAgreement:signitonlyifyouwishtobeboundbyitsterms.IfyoudonotunderstandanypartofthisAgreement,youshouldtakeindependentlegaladvice,forexamplefromalocalCitizens’AdviceBureau,LawCentre,oraSolicitor.

Signatures:

Signature

Fullname:

FullName

(Borrower)(For theLender)

Date:

Date

NOTE: TheBorrower mustbegiven acopyof thisAgreementwhen allpartieshavesigned