Loan Application

ACCOUNT NUMBER: AMOUNT REQUESTED:  
 

TERM: METHOD:

FREQUENCY: PURPOSE OF LOAN: LOAN TYPE:
WEEKLYSEMI-WEEKLYBI-WEEKLYMONTHLY

APPLICANT INFORMATION

GIVEN AND SURNAME: MARITAL STATUS:
SIN:  
Birth Date: DEPENDANTS:
TELEPHONE:  
Email:  
Driver's Licence:  

CO-APPLICANT INFORMATION

GIVEN AND SURNAME: MARITAL STATUS:
SIN:  
Birth Date: DEPENDANTS:
TELEPHONE:  
Driver's Licence:  

SALARY INFORMATION

GROSS ANNUAL SALARY :
ADDITIONAL INCOME:
CO-APPLICANT SALARY :
TOTAL ANNUAL :

ADDRESS HISTORY

PRESENT ADDRESS:
YRS THERE:
 
PREVIOUS ADDRESS:
YRS THERE:
 
PREVIOUS ADDRESS:
YRS THERE:
 

CO-APPLICANT ADDRESS HISTORY

PRESENT ADDRESS:
YRS THERE:
 
PREVIOUS ADDRESS:
YRS THERE:
 
PREVIOUS ADDRESS:
YRS THERE:
 

REFERENCES

REF NAME:
ADDRESS: RELATIONSHIP:
REF NAME:
ADDRESS: RELATIONSHIP:

WORK HISTORY

NAME/ADDRESS CURRENT EMPLOYER : TELEPHONE :
YRS THERE : OCCUPATION : DEPARMENT :
PREVIOUS EMPLOYER ( IF LESS THAN THREE YEARS) : YEARS THERE :

CO-APPLICANT WORK HISTORY

NAME/ADDRESS CURRENT EMPLOYER : TELEPHONE :
YRS THERE : OCCUPATION : DEPARMENT :
PREVIOUS EMPLOYER ( IF LESS THAN THREE YEARS) : YEARS THERE :

ASSETS

ASSETS VALUE

LIABILITIES

TYPE CREDITOR BALANCE MONTHLY

OBLIGATIONS

TYPE CREDITOR BALANCE MONTHLY

REAL ESTATE

LOCATION REGISTERED OWNER YEAR PURCH. PRICE TAXES/YR

Have you ever made a proposal under the Bankruptcy and Insolvency Act in Canada or elsewhere?

Have you ever been bankrupt or declared bankruptcy in Canada or elsewhere?

The undersigned is not indebted to any other credit union, bank, loan agency, store or individual merchant , either as maker or endorser, except as stated above. The statements herein are made for the purpose of obtaining the loan, and are true to the best of my/our knowledge and belief.

I authorize the credit union to obtain such factual and investigative information regarding me from others as permitted by law and to furnish other credit grantors and any credit bureau particulars of this credit application. In addition, I hereby acknowledge notice from the credit union that a consumer report containing credit information may or will be referred to in connection with this application for credit or any renewal or extension thereof.

I hereby authorize the credit union to deduct the costs of security registration , processing or consumer reports from my account or loan proceeds.

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