Loan Application Form
To be completed in BLOCK CAPITALS and returned to:
Haven 19 Charles Street, Milford Haven, SA73 2AA
Credit Union Or to one of our local collection points
Authorised and regulated by the Financial Services Authority Reg No 213785
Limited AN ABCUL MEMBER
Title Mr Mrs Ms Miss Member number
Marital Status Married / Divorced / Living with Partner / Single *delete as applicable
Surname Loan No : /
All correspondence will be sent to this address
unless you inform us otherwise.
Time at current * *If less than 3 years please provide details of other addresses in the past
address. three years on a separate sheet.
Date of Birth Nat Ins No.
Home Tel: Work/ Mobile Tel:
No of dependants
Employment Status employed Self retired unemployed
Employer Tel No:
Occupation /Type of Benefit Received
Time with current employer
Fixed term Y/N Time left on contract
All annual loans e.g. for Christmas or Holidays must be repaid within 12 months
Loan repayments will be made by: cash/cheque/payroll deduction/standing order *delete as applicable
Cheque to be cashed at ………………………………………………….Post office / will be paid into my bank account
*delete as applicable
Purpose of Loan
Amount of Loan £ Date loan required
Repayment Monthly/Weekly Number of of £
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Income & Expenditure Details Please include all household income & expenditure
Income Item £ per month Expenditure Item £ per month £Outstanding £Value of
Salary/wages Job 1 Rent/mortgage*
Job 2 Council tax
Partner’s Salary/wages Electricity/Gas
DLA TV/Sky costs
Other ( Please specify Groceries
Pension (please specify) Catalogues
Other income (please specify) Other Loans (please
Haven Credit Union Loan
Other Expenses (please
I declare that to the best of my knowledge I do not have any illness or life threatening condition which could affect
my insurance cover. I declare that the information I have given on this form is, to the best of my knowledge and
belief, accurate and full information. I understand that the provision of false information is fraud and that the credit
union may take appropriate action if I am found to have deliberately provided false or misleading information. I
confirm that I have read and understand the terms and conditions attached.
Applicant’s signature Print name Date
If you have declared your partner’s income details as part of your overall income for this loan, your partner will need to sign
below confirming agreement of their information to be used in considering the loan and its repayment.
Partner’s signature Print Name Date
Data Protection Statement
In accordance with the principles of the Data Protection Act 1998, we will use your personal details for the purposes of managing your
accounts with the credit union. Your personal details will be treated confidentially and will only be shared with other agencies for the
purposes of credit referencing and debt recovery, for which purpose we hold a Category F consumer credit licence.
We may at times use your details to keep you informed of services available from the credit union. If you wish your details to be used for
these marketing purposes, please tick this box ___
Please note that if you wish us to consider a guarantor on the loan he/she should also complete an
application form clearly marked “Guarantor Details”
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TERMS AND CONDITIONS
1. Loans will only be made to individuals who are over 18 years of age or above and members of the
2. All Loans are subject to approval by the Credit Committee.
3. The credit union will have a “lien” on the shares of a member for any debt due either by the
member directly or as a guarantor.
4. All information given to the credit union will be treated with the strictest confidence.
5. Where a loan application is made for the purpose of consolidation of debts, all payment(s) will be
made directly to the creditor(s) and not to the borrower.
6. All payments must be received in full, by the date and at the intervals as detailed in the loan
7. Loans will be charged at an interest rate of up to 2% per month (26.82% APR)
8. Any amounts owed on loans covered by Life Insurance which will fully repay the loan on the
death of the borrower (terms and conditions apply)
9. Applications for loans will normally only be considered from members who have saved regularly
with the credit union for a minimum of thirteen weeks. Exceptions may be made at the discretion
of the Management Committee.
10. Lump sum deposits, above the regular savings value, made within one month of any loan
application will not be considered when calculating the maximum loan available
11. Proof of income and expenditure is required for all loan applications. Additionally a credit check
for all first loans and subsequent loans over £1,000 will be made, the cost of which will be passed
on to the member.
12. First loans are limited to a maximum amount of £1,000 and must be repaid over a period of
between 3 months and12 months and fully repaid before a further application for loan can be
13. Second and subsequent loans, where previous loans have been repaid satisfactorily, are subject
to a maximum of £5000 and will be repayable over a period between 3 months to 3 years.
14. Loans granted for “periodic” purposes e.g. Christmas or Holiday expenses or quarterly bills, must
be repaid within the appropriate period, up to a maximum period of 12 months and any balance
fully repaid before a further application for loan can be made
15. If the loan has been assessed on a multiple of share value, a minimum of a third of the total loan
balance must remain in shares during the term of the loan, these shares will become attached to
the loan and will be unavailable for withdrawal.
16. Members can clear their loan balance without penalty at any time but may not lengthen the
repayment period without completion of a loan reschedule request which must be approved by
the Credit Committee.
17. If the debt is not repaid within the agreed period the debt may be passed on to a debt collection
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agency and / or court proceedings may follow to recover the amount owed. Any fees relating to
these actions will be added to the member’s debt.
18. The Credit Committee may accept another member as guarantor for a loan. The member
agreeing to be a guarantor must have enough unattached shares to cover the loan in its entirety.
Such shares will be ’locked’ and therefore, not available for withdrawal by the guarantor during
the currency of the loan being guaranteed. The guarantor’s file will be noted to that effect. The
guarantor may apply for a loan against the amount held in their unattached shares, only when the
agreed loan for which they stand as guarantor has been repaid in full.
PLEASE PROVIDE YOUR LAST THREE MONTHS BANK STATEMENTS WITH YOUR
APPLICATION, IF YOU DO NOT HAVE A BANK ACCOUNT PLEASE PROVIDE PROOF OF
INCOME AND EXPENDITURE FOR THE LAST 3 MONTHS.
REGRETTABLY, YOUR APPLICATION CANNOT BE CONSIDERED UNTIL WE HAVE
RECEIVED THESE SUPPORTING DOCUMENTS
For Official Use only
Decision approved / refused
Authorised by ………………………………………………………………. Date ………………………………………
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