WDCU | Credit Union Members Loan Application

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PLEASE NOTE: This is a 'MEMBERS ONLY' application form. If you are not a member
you should contact our Administration Office by emailing creditunion@norwich.gov.uk or visit our website at Wherry Dragon Credit Union Limited

Please fully complete the form below. All fields marked with an asterisk * are required.

In making this application, I confirm I am not a bankrupt, involved in an Individual Voluntary Arrangement, Debt Relief Order or in agreements with creditors for reduced payments or have plans to be.

ABOUT THE LOAN

How much are you looking to borrow? £ *

Repayment Frequency *

How much would you like to pay each period? (£) *

What is the loan for? *

I agree to save (minimum £10.00 a month) *

PERSONAL DETAILS

Membership Number *

Title *

First Name *

Surname *

Date of Birth *

Contact phone number (a mobile number if possible) *

Email address *

National Insurance Number *

YOUR ADDRESS

Postcode *

Address Line 1 *

Address Line 2

line3

Town

County

Country

Company (if applicable)

How long have you lived at your current address? (enter number of full years) *

If you have lived at your current address for less than 3 years please provide details below

Previous House Number or Name

Previous Address Postcode

How many individuals aged 14 years and over live in your house? (Please include yourself) *

How many children aged under 14 years live in your house? *

What is your marital status? *

Please tell us about your home *

YOUR INCOME

Monthly total of all wages after tax and any other income *

Name of employer *

Employers address *

Works email address

Works telephone number

Number of hours employed on a permanent contract

Are you in receipt of any benefits? Please indicate all that apply

Income Support
Carers Allowance
Child Tax Credits

YOUR EXPENDITURE

Total of all current debts (excluding mortgages) *

Monthly payments for existing loans, HP agreements, etc *

Bank details

Please provide you bank details. These will be used to transfer loan funds to

Bank/Building Society Name *

Address

Sort code (6 digits) *

Account No (8 digits) *

Health

Please select the health statement that applies to you *

If you selected 'I have or am being treated' above, please provide details

DECLARATION

Important Your Personal Information: Credit decisions and also the prevention of fraud and money laundering.

We may use credit reference and fraud prevention agencies to help us make decisions. What we do and how both we and credit reference and fraud prevention agencies will use your information is detailed in

A Guide to the use of your personal information by ourselves and at Credit Reference and Fraud Prevention Agencies

or you can email our Administration Office on creditunion@norwich.gov.uk for a copy.

By confirming your agreement to proceed you are accepting that we may each use your information in this way.

I authorise the Credit Union to contact any third party it deems necessary, including but not limited to, employers or credit reference agencies for reports or information. *

I consent to my personal data being held by Wherry Dragon Credit Union Limited for the purposes of this application and my membership with the credit union. *

I declare that the information I have given is to the best of my knowledge and belief true, accurate and full. *

I agree that if I default on repayments, information about my loan may be passed on to the Department for Work and Pensions for their consideration of deductions from the benefits that I am or will become entitled to. *

To complete your application please ensure your Email address is correct and then select Apply below.