= required field

Please leave this field empty.Loan Type (Please Select One):

Amount Required:

Loan Purpose

Intended Use Of Loan:

Time Period Required:

Personal Details

Member Number:

  • Title:
  • Surname:
  • First Name:
  • Date of Birth:

Current Address:

Time At Present Address:

Ownership Type:

E-mail Address:

Home Number:

Mobile Number:

Current Employment Details

Employer Name:

Employer Address:

Occupation:

Time in Employment:

Employment Type:

Net Wage/Salary:

Frequency:

Any other income:

Frequency:

State type of other income:

Spouse/Partners Details (where relevant)

Member Number:

  • Title:
  • Surname:
  • First Name:
  • Date of Birth:

Current Address:

Time At Present Address:

Ownership Type:

E-mail Address:

Home Number:

Mobile Number:

Employer Name:

Employer Address:

Occupation:

Time in Employment:

Employment Type:

Net Wage/Salary:

Frequency:

Any other income:

Frequency:

State type of other income:

Financial Details

  • Mortgage 1


  • Mortgage 2


  • Personal Loan


  • Credit Card 1


  • Credit Card 2


  • Other Loans


  • Rent

Other Details

Number Of Dependants:

Ages:

Are you a guarantor for any loan?

If Yes, Please give details:

Financial Institution:

Amount of Loan:

Monthly Repayment:

Repayment Protection Insurance

Would you like a quote for Repayment Protection Insurance? Click here for further details:

Repayment Protection Details

RPI Taken:

Initial Protection:

The benefits of Repayment Protection Insurance has been explained to me. I wish to protect my repayments.
Member Signature:

Date:

Breadwinner Protection Details

If you are not in full-time employment, you can still avail of Repayment Protection Insurance. Your repayments will be protected in the event of the breadwinner below becoming ill or redundant.
Breadwinner Name:

Breadwinner Date Of Birth:

Data Protection

(Consent to Use and Disclosure/Data Protection Acts 1998 and 2003 and Section 71 or the Credit Union Act, 1997.)
I understand that under the Data Protection Acts, 1988 and 2003 (“the DPA”), my consent may be required for the credit union to process personal data which it may have in it’s possession concerning me (including disclosure to third parties). I note that this personal data may include sensitive personal data within the meaning of the DPA, the processing of which requires my explicit consent. I also understand that under Section 71 of the Credit Union Act, 1997, the credit union, subject to exceptions listed in the Section, shall not disclose or permit to be disclosed, without my consent, any information that concerns an account or transaction of mine with the credit union. For the purpose of assessing any applications (including loan applications) which I may make to you and for generally administering and monitoring any accounts I have with the credit union, including the loan account if granted and any other loan account I have from time to time with you I consent:
o you seeking information concerning application for loans and any credit history from any credit union and from any credit reference bureau or agency operated or arranged by the Irish League of Credit Unions and for that purpose you may disclose any information in this application or which you may have concerning me to any credit union or to any such credit reference bureau or agency; and
(ii)to any credit union or any credit reference bureau or agency operated by the Irish League of Credit Unions disclosing information concerning applications for loans and my credit history with any credit union or otherwise; and
to the disclosing of any information in any application (including loan applications) or in respect of any account or transaction of mine with the credit union from the date of my original consent to officers or employees of the Irish League of Credit Unions for the purpose of fulfilling our requirements and under the Savings Protections Scheme if such scheme is operated on behalf of the credit union by the Irish League of Credit Unions; and
(iv) to the processing of any information relating to me, either contained in this form or otherwise, for the purpose of assessing applications and administering any accounts I maintain with the credit union.
From time to time, the Credit Union, or third parties selected by the Credit Union, may use your details to inform you of goods and/or services which may be of interest to you. The use of your details for marketing purposes will depend on the preferences that you express below

Opt in (marketing by email, text message and fax)

Opt Out (other forms of marketing)

Signature

Declaration

I am not indebted to any other Credit Union, bank or loan agency either as a borrower or guarantor, except as stated above.
I confirm that I have the financial means to repay this loan.
It has been explained to me that my shares will be held as security for this loan.
I / We have read and understood the particulars which have been completed in this application and declare that they are true, correct and contain no material omission and have been made to the credit union to enable them to determine whether or not to grant the application and if so, the terms and conditions on which the loan will be offered, approved or granted.
I / We understand that this is an application and as such does not imply that a loan will be offered, approved of granted.

  • Signature:
  • Signature Date:

Irish Credit Bureau Consent

1. The information which is held on the ICB database relates to credit agreements between these ICB members and their customers/members. A condition of such agreements is that the customer/member agrees that the financial institution/Credit Union may use the data supplied for the purpose of credit checking. Consequently, where an individual enters a credit agreement with an ICB member, details of the individual’s performance in complying with the terms of the agreement are input to the ICB credit file database, which may be accessed by all member institutions of ICB.
2.Each time a person applies for credit from an ICB member, that institution accesses the ICB’s "credit file" to ascertain the applicant’s performance under any previous credit agreements with ICB members.
3. In addition to paragraphs 1 and 2 above, I/We further consent to and authorise to process and retain data provided by me/us in respect of this application, to seek and provide credit references (searches), to record details of any transaction relating to a loan or other credit which may result from this application with Irish Credit Bureau Ltd (ICB) for a period of 5 years from the date of closure of the loan and ICB to record, retain and disclose to it's members details of such searches for a period of 1 year.
I/We acknowledge that and/or the ICB are permitted to disclose any material misstatement of the fact contained in the application for financial accommodation to it's members and relevant bodies. I/We consent to any such application being processed, recorded and retained by ICB. Please note that you have the right to access personal data held about you by the Credit Union and to correct any inaccuracies in such data.

  • Members Signature:
  • ICB Signature Date: