"Personal Credit Loan Application Form - Uwi (Mona) & Community Co-operative Credit Union Limited"

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UWI (MONA) & COMMUNITY CO-OPERATIVE CREDIT UNION LIMITED
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FOR INTERNAL USE ONLY
Branch/ Transit
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FFICE
ECH
Membership Number:
Date of Application:
1. PERSONAL INFORMATION
NAME OF APPLICANT (SURNAME, FIRST NAME, MIDDLE NAME)
DATE OF BIRTH (YYYY/MM/DD)
T.R.N
ACCOUNT #
CURRENT HOME ADDRESS
OWN. RENT. OTHER (Please specify)
YEARS THERE
MAILING ADDRESS IF DIFFERENT FROM HOME ADDRESS
HOME TELEPHONE #
FAX/CELLULAR #
PREVIOUS HOME ADDRESS
YEARS THERE
E-MAIL ADDRESS
NAME AND ADDRESS OF NEAREST RELATIVE NOT LIVING WITH YOU
RELATIONSHIP
TELEPHONE #
# OF DEPENDENTS
AGE (S) OF EACH
STATUS
DATE OF MEMBERSHIP (YYYY/MM/DD)
2. EMPLOYMENT INFORMATION
NAME OF EMPLOYER
YEARS THERE
OCCUPATION/TYPE OF BUSINESS
Permanent Temporary Contract Self Employed
ADDRESS OF EMPLOYER
EMPLOYEE #
TELEPHONE #
Contract Expiry Date (YYYY/MM/DD)
/
/
NAME OF PREVIOUS EMPLOYER
YEARS THERE
OCCUPATION/TYPE OF BUSINESS
Permanent Temporary Contract Self Employed
ADDRESS OF PREVIOUS EMPLOYER
TELEPHONE #
Contract Expiry Date (YYYY/MM/DD)
/
/
3. SPOUSE’S EMPLOYMENT INFORMATION
NAME OF SPOUSE (SURNAME, MAIDEN NAME (if applicable), FIRST NAME, MIDDLE NAME)
DATE OF BIRTH (YYYY/MM/DD)
T.R.N.
/
/
NAME OF EMPLOYER
YEARS THERE
OCCUPATION/TYPE OF BUSINESS
ADDRESS OF EMPLOYER
TELEPHONE #
NAME OF PREVIOUS EMPLOYER
YEARS THERE
OCCUPATION/TYPE OF BUSINESS
ADDRESS OF PREVIOUS EMPLOYER
TELEPHONE #
4. CO-MAKERS / GUARANTOR’S (IF APPLICABLE)
Name 1:
Amount:
Name 2:
Amount:
Name 3:
Amount:
Name 4:
Amount:
Name 5:
Amount:
Name 5:
Amount:
5. LOAN DETAILS
REPAYMENT SOURCE:
LOAN PURPOSE
SALARY DEDUCTION
POST DATED CHEQUE
LOAN AMOUNT $
COUNTER
STANDING ORDER (ACCOUNT # & Institution)
COLLATERAL SECURITY HELD AND/ OR PROPOSED
Mortgage
$
Instrument of Charge
$
Insurance
$
Hypothecation
$
Bill of Sale
$
Other
$
6. INCOME AND EXPENDITURE STATEMENT
INCOME
$
EXPENDITURE
$
Gross Monthly Family Income
Car Loan Payment
Less Deduction At Source
Hire Purchase Payments
Net Income (Take Home Pay)
Life Insurance Premiums
Other Income
Other Loan Payments
TOTAL INCOME
Rent
Mortgage, Maintenance
Insurance, Home, Vehicle
Transportation Expenses
Utilities – Telephone, Water, Electricity
Living Expenses – Food, Clothing, etc.
Educational Expenses – School Fees, etc.
Medical, Dental, Optical Expenses
Entertainment
Other
TOTAL EXPENSES
SURPLUS (DEFICIT)
7. STATEMENT OF LIABILITIES
LIABILITIES
$
$
ASSETS
$
$
$
MORTGAGE
PAYMENTS
MONTHLY
BALANCE
REAL ESTATE (incl. address,
INSURANCE
MEMBER
LOANS OFFICER
PAYMENTS
OUTSTANDING
volume and folio numbers)
COVERAGE
VALUATION
VALUATION
(financial Institution, branch)
Current
AMOUNT
(Y/N)
LIEN HOLDER
CHATTELS (Motor vehicle,
Furniture, Equipment, Other)
UWI (MONA) & COMMUNITY CO-OPERATIVE CREDIT UNION LIMITED
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P
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L
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A
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P
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A
T
I
O
N
-
P
E
R
S
O
N
A
L
C
R
E
D
I
T
FOR INTERNAL USE ONLY
Branch/ Transit
H
O
UT
EAD
FFICE
ECH
Membership Number:
Date of Application:
1. PERSONAL INFORMATION
NAME OF APPLICANT (SURNAME, FIRST NAME, MIDDLE NAME)
DATE OF BIRTH (YYYY/MM/DD)
T.R.N
ACCOUNT #
CURRENT HOME ADDRESS
OWN. RENT. OTHER (Please specify)
YEARS THERE
MAILING ADDRESS IF DIFFERENT FROM HOME ADDRESS
HOME TELEPHONE #
FAX/CELLULAR #
PREVIOUS HOME ADDRESS
YEARS THERE
E-MAIL ADDRESS
NAME AND ADDRESS OF NEAREST RELATIVE NOT LIVING WITH YOU
RELATIONSHIP
TELEPHONE #
# OF DEPENDENTS
AGE (S) OF EACH
STATUS
DATE OF MEMBERSHIP (YYYY/MM/DD)
2. EMPLOYMENT INFORMATION
NAME OF EMPLOYER
YEARS THERE
OCCUPATION/TYPE OF BUSINESS
Permanent Temporary Contract Self Employed
ADDRESS OF EMPLOYER
EMPLOYEE #
TELEPHONE #
Contract Expiry Date (YYYY/MM/DD)
/
/
NAME OF PREVIOUS EMPLOYER
YEARS THERE
OCCUPATION/TYPE OF BUSINESS
Permanent Temporary Contract Self Employed
ADDRESS OF PREVIOUS EMPLOYER
TELEPHONE #
Contract Expiry Date (YYYY/MM/DD)
/
/
3. SPOUSE’S EMPLOYMENT INFORMATION
NAME OF SPOUSE (SURNAME, MAIDEN NAME (if applicable), FIRST NAME, MIDDLE NAME)
DATE OF BIRTH (YYYY/MM/DD)
T.R.N.
/
/
NAME OF EMPLOYER
YEARS THERE
OCCUPATION/TYPE OF BUSINESS
ADDRESS OF EMPLOYER
TELEPHONE #
NAME OF PREVIOUS EMPLOYER
YEARS THERE
OCCUPATION/TYPE OF BUSINESS
ADDRESS OF PREVIOUS EMPLOYER
TELEPHONE #
4. CO-MAKERS / GUARANTOR’S (IF APPLICABLE)
Name 1:
Amount:
Name 2:
Amount:
Name 3:
Amount:
Name 4:
Amount:
Name 5:
Amount:
Name 5:
Amount:
5. LOAN DETAILS
REPAYMENT SOURCE:
LOAN PURPOSE
SALARY DEDUCTION
POST DATED CHEQUE
LOAN AMOUNT $
COUNTER
STANDING ORDER (ACCOUNT # & Institution)
COLLATERAL SECURITY HELD AND/ OR PROPOSED
Mortgage
$
Instrument of Charge
$
Insurance
$
Hypothecation
$
Bill of Sale
$
Other
$
6. INCOME AND EXPENDITURE STATEMENT
INCOME
$
EXPENDITURE
$
Gross Monthly Family Income
Car Loan Payment
Less Deduction At Source
Hire Purchase Payments
Net Income (Take Home Pay)
Life Insurance Premiums
Other Income
Other Loan Payments
TOTAL INCOME
Rent
Mortgage, Maintenance
Insurance, Home, Vehicle
Transportation Expenses
Utilities – Telephone, Water, Electricity
Living Expenses – Food, Clothing, etc.
Educational Expenses – School Fees, etc.
Medical, Dental, Optical Expenses
Entertainment
Other
TOTAL EXPENSES
SURPLUS (DEFICIT)
7. STATEMENT OF LIABILITIES
LIABILITIES
$
$
ASSETS
$
$
$
MORTGAGE
PAYMENTS
MONTHLY
BALANCE
REAL ESTATE (incl. address,
INSURANCE
MEMBER
LOANS OFFICER
PAYMENTS
OUTSTANDING
volume and folio numbers)
COVERAGE
VALUATION
VALUATION
(financial Institution, branch)
Current
AMOUNT
(Y/N)
LIEN HOLDER
CHATTELS (Motor vehicle,
Furniture, Equipment, Other)
OTHER AMOUNTS OWED
OTHER ASSETS (share
certificate, etc)
(excluding the above)
LIFE INSURANCE POLICIES
LIFE INSURANCE POLICIES
PREMIUMS
C.S.V.
C.S.V.
(insurer, policy date, face
(loans)
Current (Y/N)
value)
LOANS (financial institution,
DEPOSIT ACCOUNTS (financial
ACCOUNT #
BALANCE
BALANCE
branch)
institution, branch)
$
$
TOTAL ASSETS
TOTAL LIABILITIES
NET WORTH
8. MEMBER’S DECLARATION
I hereby apply for a loan of $
and confirm that the information given is true in all respects, accurate and complete and that I have not withheld any
information that might affect the Credit Union’s decision. I am agreeable to the Credit Union taking such steps, as it may deem necessary to verify any of the
information given. The Credit Union is authorised to charge my account with the monthly payments on due dates and I agree to pay all appropriate charges for any
overdue instalments. The Credit Union is authorised to provide information to credit bureaus and other credit grantors as permitted by law and to send me
information about other services. I agree to pay all fees associated with the processing of the loan.
DATE
APPLICANT’S SIGNATURE
WITNESS
DATE
COMAKER’S\ GUARANTOR’S SIGNATURE
WITNESS
DATE
COMAKER’S\ GUARANTOR’S SIGNATURE
WITNESS
DATE
COMAKER’S\ GUARANTOR’S SIGNATURE
WITNESS
FOR CREDIT UNION USE ONLY
INTERVIEWED BY: NAME/TITLE
VERIFIED BY: NAME/TITLE
CREDIT SCORE:
DEBIT/EQUITY RATIO
LOANS OFFICER’S ESTIMATED SURPLUS
$
LEGAL FEES
$
REGISTRATION FEES
$
PROCESSING FEES
$
OTHER FEES
$
SHARE BALANCE
$
LOAN CODE
DEPOSIT BALANCES
$
SECURITY CODE
CURRENT LOAN BALANCES
$
OTHER CODE (SPECIFY)
REPAYMENT PERIOD
INTEREST RATE
PROPOSED MONTHLY REPAYMENT
$
REPAYMENT RECORD ON PREVIOUS LOAN
ORIGINAL LOAN BALANCE
$
DATE OF LAST LOAN:
Excellent
Good
Poor
REPAYMENT RECORD:
LOAN COMMITTEE/CREDIT COMMITTEE DECISION:
APPROVED
DISAPPROVED
ON
A LOAN OF $
(DATE)
MEMBER OF COMMITTEE
WAS APPROVED/DISAPPROVED ON THE FOLLOWING CONDITIONS/OTHER COMMENTS:
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