AttonBank Loan Application

To apply for a loan, please complete all sections of this form. Please provide the photos of your
government issued personal ID along with the driver's license with this application.

Section One – Personal Details

Title …………………

First Name/s ………………………………………………………………………………………………………………………………………………

Surname ………………………………………………………………………………………………………………………………………………

Nat Ins. Number ……………………………………………………………

Date of Birth ……….. /……… /………..

Marital Status ……………………………………………………………

Number of Dependents …………………

Ages of Dependents ………………………………………………………………….

Residency Status UK Citizen EU Citizen Non-EU Citizen

Section Two – Address Details

Current Address ………………………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………………………

Postcode ………………………………

Date Moved to Address ……….. /……… /………..

Residential Status Home Owner Private Tenant Council / HA Tenant

Living with Parents Shared Accommodation

If you have been at your current address for less than three years, please provide your previous address. If you have
lived at more than two addresses in the last three years please provide additional addresses on a separate piece of
paper.

Previous Address ………………………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………………………

Postcode ………………………………

Date Moved to Address ……….. /……… /………..

If you have had more than two addresses in the last three years, please provide us with all further details in the
Additional Information section of this form, or on a separate piece of paper.
Section Three – Contact Details

Please provide at least one phone number and your e-mail address if you have one. If you provide a mobile number,
we can send you text messages with information on the progress of your application. We will also send you an
e-mailconfirming the final decision on your application.

Home Tel No …………………………………………………………………………………………

Mobile Tel No …………………………………………………………………………………………

Email Address …………………………………………………………………………………………

Section Four – Employment Details

If you are not currently employed, please proceed to the next section.

Employment Status …………………………………………………………………………………………

Current Employer …………………………………………………………………………………………

Address ………………………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………………………

Postcode ………………………………

Work Tel No ………………………………………………………………………………………… (including extension if applicable)

Job Title ………………………………………………………………………………………………………………………………………………

Employment Status Full Time Part Time Self Employed

Type of Contract Permanent Temporary Fixed Term

Contract Expiry Date ……….. /……… /……….. (if applicable)

Date Joined Employer ……….. /……… /………..

Section Five – Loan Details

Amount Requested USD………………………………

Purpose of Loan ………………………………………………………………………………………………………………………………………………

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Please explain your need fully. If your loan request is to cover multiple items, please itemise
them and provide an estimate of the cost for each.
Section Six – Income and Expenditure

Total Monthly Income USD………………………………

Rent / Mortgage Cost USD………………………………

Household Bills USD………………………………

Other Regular Expenses USD………………………………

Section Six – Additional Information

Is there any other information regarding your application that you would like to tell us about?

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Section Seven – Using Your Information

Your information may be processed by us in any form and on any database used by us for the following purposes:

 To consider any applications made by you;

 To deal with your account(s) or run any other services we provide to you;
 To undertake statistical analysis, money laundering checks (which may include telephoning you), compliance and
regulatory reporting, and fraud prevention;
Section Eight– Declaration

I declare to the best of my knowledge and belief, that:

1. I am / am not in good health and I am fit / not fit to follow my normal occupation. (Delete as applicable)
2. I authorise the AttonBank to obtain any further information as required from my employer or credit reference
agency.
3. All statements contained in this application are complete and accurate to the best of my knowledge and belief
and I acknowledge that if any information given in this application proves incomplete or inaccurate, any loan to
me as a result of this application may become immediately repayable to the AttonBank.
4. I understand that the provision of false information is fraud and that the AttonBank may take
appropriate action if I am found to have deliberately provided false or misleading information.
5. I understand that in the event of the loss of my income / employment due to an accident, redundancy, or
sickness, I will still be required to make my agreed loan repayments.

Applicant’s Signature ………………………………………………………… Date Signed ……….. /……… /………..