Synergy Credit Union

Loans Apply Now

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

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 Amount

Balance Outstanding

Monthly Repayment Amount

Bank/Building Society:

€

Rent/Mortgage:

€

Credit Card:

€

Other:

€

Previous Credit Union Loans

Amount

Date

Repayment Amounts

Repayment Frequency

Current Savings Balance(s):

€ *

Current Loan Balance(s):

€

Current Arrears:

€

Loan Details

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
And that: * I am fit to follow my normal occupation I am NOT fit to follow my normal occupation
Signature of Applicant:	*
Date Signed:	*
Data Protection Act 1988 - I consent to the information contained in this application form being used by the Credit Union for the purposes of processing my application

Verification

Loans