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Tel: (056) 7724445 Fax: (056) 7754229

Sun 05-Nov-2017
Loans 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: 
E-mail Address: 
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:
€ € €
Rent/Mortgage:
€ € €
Credit Card:
€ € €
Other:
€ € €
Previous Credit Union Loans
»
AmountDateRepayment AmountsRepayment Frequency
1:
2:
3:
Current Savings Balance(s):€   *
Current Loan Balance(s):€  
Current Arrears:€  
Loan Details
* Required Fields
I wish to apply for a loan of:€   *
Purpose of Loan:  *
Date Required:  *
To be repaid every:  *
In installments of:€   *
Declaration
* 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
Irish Credit Bureau Consent
* Required Fields
I authorise Thomastown Credit Union Ltd. to process and retain data provided by me in respect of this application, to seek and provide credit references (searches) from/to Irish Credit Bureau Limited (ICB), to record details of any transaction which may result from this application with ICB and for ICB to record, retain and disclose to its members details of such searches for a period of one year.

I am aware that loan information is retained by ICB for a period of 5 years from the date of repayment in full/closure of an account.

I consent to any such application being processed, recorded and retained by ICB.
Name:  *
Date:  *
Please enter the code shown:
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Helps prevent automated form submissions.
More Info
 
  • Thomastown Credit Union
  • Tel: (056) 7724445
  • Fax: (056) 7754229
  • Email: info@thomastowncreditunion.ie
Regulated by the Central Bank of Ireland: Reg No. 39CU