Loan Application Form Name  Home Address  Date of Birth  C.U. Account No  Telephone:  Home: Work: E-mail Address: Personal Details Weekly Income € Residential Status Owner   Tenant Living with family How long at current residence years Monthly Mortgage/Rent Repayments € Marital Status Married Co-habitating Single Widowed Seperated / Divorced   Number of Dependants   Spouse / Partner Details Spouse / Partner Name Spouse / Partner Occupation Spouse / Partner Employers Name Spouse / Partner Weekly Income €     Loan Details Loan Amount  € Loan Purpose Repayment Details Choose a loan term,  monthly and weekly repayment are automatically calculated for you. Loan Term  0 0.5 1 2 3 4 5 6 7 8 9 10 Years Minimum Repayment  € Monthly      € Weekly Repayment Freq. Weekly Fortnightly Monthly Quarterly Yearly Work Details Employer's Name: Work Address: Occupation/Grade: Length of Service: years Self Employed: Yes No No of Employees:  Before your loan is approved you must sign a declaration of health form. Are you able to sign such a form Yes No Note: Additional information may be required by The Lough Credit Union before your loan application is considered.   Please note this form is submitted to Sample Credit Union via email. If you prefer not to submit your loan application via e-mail, applications can also be made at our office or if you prefer over the phone.   Home | About Us | Savings | Loans | Services | Office | News | Links | Faq | Kid's Corner The Lough Credit Union Limited 100-103 Bandon Road, Cork. Tel: 021 4963384 Fax: 021 4964734 Email: info@loughcu.ie