IMPORTANT: before any loan can be approved, we will require in addition to full completion of this form, the following items to be provided:

Your last TWO wage slips (or entitlement of income) AND bank statements
Acceptable forms of personal identity – please ensure you are able to produce these

Acceptable forms of Personal Identity (original or copies) we require:

One form of photo ID
Examples: Driving Licence, Passport, CIS Card, Work Pass or Identity Card MoD ID Card, Blue Disabled Drivers Pass

One form of proof of address
Examples: Utility Bill dated in the last 3 months, Tax Notification, Letter from official source, such as Council, Government Department, School, University, College, Bank, Insurance Company, Building Society, Solicitor, Police, Bank or Building Society Statement, Credit Card Statement, Building Society or Savings Pass Book, Council Tax Bill, Official Rent Book, TV Licence, Printed Wage Slip.

Failure to provide the required documents may result in the loan application being delayed or denied altogether.

By signing this application form I agree that: I am over eighteen years of age. When entering this agreement I am not or about to be entered into a Debt Management Programme, involved in an IVA or a Debt Relief Order, and I am not an undisclosed bankrupt at the time of signing. I understand that it is a criminal offence to to obtain monies by deception. All the details stated are true and complete. I authorise you to obtain any such reference to my credit worthiness as you may in your absolute discretion think fit. I further understand that you may decline this application without disclosing your reasons.

PERSONAL DETAILS – please complete all sections

Title*

Mr
Mrs
Miss
Ms

Full Name*

First Last

Date of Birth*

Full Address*

Address Line 1 Address Line 2 City County Postcode

How long have you lived at this address?

Please use numbers e.g. '10', not 'ten'

Years*

Months*

Home*

Council
Owner
Tenant (Housing Assoc.)
Living With Parents
Private Tenant Agreement (Please supply tenant agreement)

Home Telephone Number

Mobile Number*

Email Address*

Maiden / Previous Name

No. of Dependents

N.I. Number

Previous Address (if less than 3 years)*

Address Line 1 Address Line 2 City County Postcode

Name and Address of Nearest Relative (not at your current address)

Name*

First Last

Address*

Address Line 1 Address Line 2 City County Postcode

Relationship to you*

Name and Address of someone who has known you for more than three years and will give you a reference (different from your nearest relative)

Name*

First Last

Address*

Address Line 1 Address Line 2 City County Postcode

Your Partner’s Full Name

First Last

AFFORDABILITY STATEMENT

NOTES – please read

By completing this application you are agreeing that the lender may search their records for information about you and with credit reference & fraud prevention agencies who will record details of the search. If you borrow, details of how you conduct your account (including going into default) may be disclosed to the agencies.

Any information provided to the lender or others may be used for making decisions regarding you, members of your financial household or others to whom you are linked financially. Information may also be used for debt tracing, fraud prevention and the prevention of money laundering.

If you are making a joint application in the absence of the other party or if you state a financial association with another person, you are declaring that you are entitled to disclose information about them and to authorise the lender to search, link and record information about you and anyone referred to by you, with credit reference agencies.

This application may be assessed with reference to records of other people with whom you are linked with financially, unless those links have been severed.

You have the right to be told which credit reference agencies the lender has used and a right to obtain a copy of your credit file from the appropriate credit agency.

Do you have any other personal loans or credit*

Yes (Tick and give details of all Credit in box provided)
No

List

Company	Amout Per Week (£)

Amount of Loan Required*

Reason For The Loan*

How much extra can you afford to spend each week?*

Where did you hear of us?

INCOME AND EXPENDITURE WEEKLY / MONTHLY

Income

My income has not changed
My income details are as follows (if ticked/marked please complete)

Your Income. either weekly or monthly

Your Wages*

Is this a weekly or monthly wage?*

Partner's Wages

Is this a weekly or monthly wage?

Benefits Payments

Is this a weekly or monthly payment?

Other Income

Is this weekly or monthly income?

Total

Expenditure

My expenditure has not changed
My expenditure details are as follows (if ticked/marked please complete)

Your expenditure, either weekly or monthly

Please clearly state if this is weekly, fortnightly, monthly, last working day or otherwise.

Rent/Mortgage

Council Tax

Electric

Gas

Water

Monthly Phone Bill

Housekeeping/Food

Travel/Transport

Credit Account / H.P.

TV Licence

Total other expenditure

Monthly Total

Do you hold a credit card?*

Yes
No

Do you hold a debit card?*

Yes
No

Do you hold a store card?*

Yes
No

Employment Status

Occupation Type*

Occupation

Length of Employment (Years / Months)

Name of Employer

Address of Employer

Address Line 1 Address Line 2 City County Postcode Country

Employer's Phone Number

Payroll Number

Bank Details

Bank

Account Number

Sort Code

Bank Address

Address Line 1 Address Line 2 City County Postcode

Signature

Date:

REMEMBER – to process your application we first need from you the following:

• Your last TWO wage slips or entitlement of income • Your last TWO bank statements (itemised please) • TWO other acceptable proof of personal identity (original or copies as per list above)

You can use the upload box below to send us photos or scans of the documents. Alternatively, submit your form without them and we will get in touch with alternate methods of sending us the documents

Your documents

Drop files here or

Accepted file types: jpg, jpeg, png, tiff, pdf, gif, bmp, Max. file size: 50 MB.

Application Form

How long have you lived at this address?

AFFORDABILITY STATEMENT

INCOME AND EXPENDITURE WEEKLY / MONTHLY

Bank Details

01442 266614