Super Form – Dundalk Credit Union

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Unique ID (from Lead)

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Status

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Topic

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How much do you wish to borrow?

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Calculated Rate

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For how long? (in years)

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Your Monthly Loan Repayments Will Be:

Interest calculated at 8.95% variable rate (9.3% APR).

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fortnightly repayment

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weekly repayment

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Total Cost of Credit

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Name*

First Last

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Email*

Please enter your personal email address.

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Phone*

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Consent*

I agree to the terms and conditions for access to and use of the Credit Union website and web forms.

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Please fill in your Date of Birth*

Do you know your membership number?

Yes
No

Please enter your membership number:

Marital Status

What is your PPS number?*

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Please enter your home address*

Address Line 1 Address Line 2 Town County Country

Living Situation*

Home Owner
Tenant
Living with Parents

Number of Residents Living At This Address*

Years living at this address*

If resident for less than 3 years please supply previous address

Previous Address

Address Line 1 Address Line 2 Town County Country

Employment Status

Are you a public sector employee?

Yes
No

Employment Type

Employer Name*

Employer Address*

Address Line 1 Town County Country

Time in current Employment (in years)*

Loan Application Amount*

Loan Purpose

Other loan purpose

Term of Loan (in years)*

Repayment Frequency

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Monthly Repayment

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fortnightly repayment

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weekly repayment

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Repayment Amount

Repayment Method

Loan Funds Payout Method

Monthly Take Home Pay*

After Tax & Deductions

Are you in receipt of social welfare payments?*

Yes
No

What is the total monthly amount of social welfare payments you receive?*

E.g. Child Benefit, Job Seeker's Allowance, Family Income Supplement etc.

Are you in receipt of rental income?

Yes
No

Monthly Rental Income

If Applicable

Do you have other monthly income?

Yes
No

Other Monthly Income

After Tax & Deductions

Type of Monthly Outgoing

Amount

Do you have an additional monthly outgoing?

Yes
No

Type of Monthly Outgoing

Amount

Do you have a further monthly outgoing?

Yes
No

Type of Monthly Outgoing

Amount

Do you have a further monthly outgoing?

Yes
No

Type of Monthly Outgoing

Amount

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Total Monthly Outgoings

Please consider any Mortgages, Loans, Credit Cards, Overdrafts etc.

Declarations and Consents - please read carefully before submitting

Below, the terms ‘we’ or ‘us’ refer to the Credit Union.
Below is important information relating to your application. Please do not submit an application before reading all the information carefully.

l hereby apply to the Credit Union for a Personal Loan subject to the Loan Terms and Conditions of the Credit Union. By ticking the box I confirm that I have read and understood the terms and Conditions.

Are you aware of any known future changes to your circumstances which may affect your ability to repay the proposed loan?

Yes
No

Please provide details:

Are you an employee, director or volunteer of the Credit Union?

Yes
No

Please provide details:

Are you connected to or related to an employee or director of the Credit Union or connected to a business where an employee or director of the Credit Union is a significant shareholder?

Yes
No

Please provide details:

Have you or are you, or any business associated with you; ever been declared bankrupt or insolvent, obtained a Debt Relief Notice, renegotiated your arrangements with creditors or faced court proceedings for debts in Ireland or any other jurisdiction?

Yes
No

Please provide details:

Authorisation and Application

Warning: If you do not meet the repayments on your credit agreement, your account will go into arrears. This may affect your credit rating, which may limit your ability to access credit in the future.

I confirm, acknowledge and agree;

That this Application Web Form together with figures quoted in repayment calculators may not be construed as an offer of credit by or on behalf of the Credit Union.
That all statements, information and details given in this application and any documentation provided in support of it are true, accurate and complete and I understand they are subject to verification by the Credit Union.
That the Credit Union may contact my employer to verify my employment details and/or salary information for the purposes of underwriting this application.
That loan approval is subject to the Credit Union’s credit approval process and lending criteria and that the Credit Union reserves the right to restrict, amend, reduce or withdraw any loan offer made.
That the loan will be subject to the rates and interest of the Credit Union and I will pay all fees and charges in connection with the loan as set out in the Credit Agreement that will issue to me on the approval of my application.
That the Credit Union may obtain Repayment Protection Insurance in relation to this credit facility and that availability of such insurance will be subject to a Declaration of Health within the Credit Agreement.
That loan approval may be subject to conditions as specified in the Credit Agreement. This may include that my shares may be held as security against the loan.
That upon execution of the Credit Agreement by the Credit Union and I, we will both be bound by that Credit Agreement.

Consent for Authorisation and Application*

By ticking the box I confirm and acknowledge the above

Data Processing

By ticking the box I consent to the Processing of my data, which may include sensitive data, for the purposes of reviewing this application in accordance with the Privacy Notice

Credit Checks

STATUTORY NOTICE – Central Credit Register (CCR):

Under the Credit Reporting Act 2013 lenders are required to provide personal credit information for credit applications and credit agreements of €500 and above to the Central Credit Register. This Information will be held on the Central Credit Register and may be used by other lenders when making decisions on your credit applications and credit agreements.

The Central Credit Register is owned and operated by the Central Bank of Ireland. For more information please see: www.centralcreditregister.ie

It is a necessary condition of a credit application that satisfactory credit checks and assessments be conducted by the Credit Union. These will include checks with the Central Credit Register and/or the Irish Credit Bureau DAC or other credit reference agencies.*

By ticking the box I authorise the Credit Union to conduct additional credit verifications and assessments as necessary for the purposes of considering my application in accordance with the Credit Checks Notice

Receive Certain Notices Electronically

From time to time the credit union would like to send Notices to you electronically including notice of annual general meetings, special general meetings and our annual report. This will allow us to reduce costs and be more environmentally friendly. Please be aware it is a regulatory requirement that Notices may only be sent electronically to personal email addresses and may not be sent to addresses associated with your work or employment.

By ticking the box I consent to receiving certain Notices electronically

Marketing Consent

From time to time, the Credit Union may wish to inform you of goods, services, products, competitions, promotional offers and Credit Union news which may be of interest to you. The use of your details for these purposes will depend on the preferences that you express below. You can update your preferences at any time by contacting us by letter or phone. Please note, the Credit Union may still contact you where there is a legal or legitimate interest basis for that contact.

Yes, I would like to be contacted by:

Email
Text Message
Post
Phone

You can select more than one option

No, I do not want to be contacted:

You can contact the Credit Union in the future if you change your mind and no longer wish to receive marketing communications. You can contact the Credit Union by; You can contact the Credit Union by;

Phone	(042) 93 35489
Website	www.dundalkcu.ie
In branch	Market Street, Dundalk Co. Louth A91 YH90, Ireland

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credit union id

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Loan Type