Tel: 0151 256 5582 Email:

27 April 2017
Online Loan Application Form

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:
Employment Details
* Required Fields
Employer: *
Work Address: *
Occupation: *
Length of Service: *
Weekly Salary:£ *
Other Income:£
Payroll Number:
Spouse/Partners Details (where relevant)
* Required Fields
Spouse/Partners Name:
Spouse/Partners Employer:
Employers Address:
Spouse/Partners Occupation:
Spouse/Partners Weekly Income:£
Any Other Income:£
Spouse/Partners Date of Birth:
Current Financial Situation
* Required Fields
I declare that I am indebted to the following:
Original AmountBalance OutstandingMonthly Repayment Amount
Bank/Building Society:
£ £ £
£ £ £
Credit Card:
£ £ £
£ £ £
Previous Credit Union Loans
AmountDateRepayment AmountsRepayment Frequency
Current Savings Balance(s):£ *
Current Loan Balance(s):£
Current Arrears:£
Loan Details
* Required Fields
I wish to apply for a loan of:£ *
Pupose of Loan: *
Date Required: *
To be repaid every: *
In installments of:£ *
* Required Fields
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: *
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
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Helps prevent automated form submissions.
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Norris Green Community Credit Union Tel: 0151 256 5582 Email: Web:
Norris Green Community Credit Union is authorised by the Prudential Regulation Authority & regulated by the Financial Conduct Authority & the Prudential Regulation Authority. FRN: 213404