THE COMMUNAL CO-OP CREDIT UNION LTD.

Loan Application Form

Branch:
Name: A/c no: Date:

Address: Code: Ref. no.

Address Since: Lives in: Date of Birth:
T/phone no. Home: Work: Cell: Member since:
Former address (if less than 1 yr. at present)
How long: Identification - Type: I.D. No.
Marital Status: Dependents (numb.): Ages: Other C/U Membership: (name)
Landlord(Name, address & phone):
Employer: Position or Occupation:
Employer's Add: Length of employment:
Former Employer: (if less than 3
yrs. at present) How Long: E-mail:
Former Position or occupation: Banker:
Co-appl/Co-borrower
Name: A/c no:

Co appl. address Code: Ref. no.

Address Since: Lives in: Date of Birth:
T/phone no. Home: Work: Cell: Member since:
Former address (if less than 1 yr. at present) E-mail:
How long: 0yrs Identification - Type: I.D. No.
Marital Status: Single Dependents (numb.): 0 Ages: Other C/U Membership: (name)
Landlord(Name, address & phone):
Employer: Position or Occupation:
Employer's Add: Length of employment:
Assets & Liabilities
Assets Description Value Liabilities Monthly pmts.
$ $ $
$ $ $
$ $ $
$ $ $
$ $ $
$ $ $
$ $ $
$ $ $

TOTALS $ $ $

Net Worth: $
BUDGET
Taxes $ Electricity $ Rent $

NIS $ Water $ Mortgage $

Pension/medical Ins. $ Telephone & I-net $ Other Loans $

Insurance (veh & house) $ Cable $ New Loan Payment $

Educ. & child maintenance $ Hire Purchase $

Food $ SUB TOTAL $

Travel & vehicle $

Miscellaneous(med, clothes) $
Other (entertainment etc.) $

SUB TOTAL $ SUB TOTAL $ Total Expenses $

Gross Salary $ Co-appl. income $ Total Income $
Allowances $ Residue $ DSR
Other income $

Other (state sources)

Total main appl inc. $

Loan Purpose:
Amount: $

Repayment Period:
Interest Rate:
Mthly Repayment:
PROPOSED DISBURSEMENT
1

2
3

4
5

6
7
TOTAL $

SECURITY

4
References: (Name, address, telephone nos., occupation & relationship. Relatives or friends not living with applicant)
Name: Name:
Address: Address:
Occupation: Occupation:
Telephone: Telephone:
Relationship: Relationship:
I/We confirm that the information given herein is true to the best of my/our knowledge, and that all outstanding financial obligations and commitments are declared. I/We understand clearly that it is being used to
determine my/our Credit responsibility and for the purpose of obtaining the loan. I/We hereby authorize The Communal Co-operative Credit Union Ltd. to obtain any information they may require from any institution,

Signature of Applicant: Date:

Signature of Applicant: Date:
Witness:
Home Occupancy Employment status Savings contribution Score /24

Own 5 Permanent F/T 4 75-99% 5

Rent unfurnished 3 Permanent P/T 3 50-74% 4

Rent furnished 2 Contract/Temp 2 21-49% 3

Room & Board 1 Self-employed 1 15-20% 2

Length of Residency Employment tenure 10-15% 1

over 10 yrs. 4 over 10 yrs. 5 <10% 0

6-10 yrs. 3 6-10 yrs. 4

3-5 yrs. 2 3-5 yrs. 3 Net worth

1-2 yrs. 1 1-2 yrs. 2 Positive 1

Less than 1 yr 0 Less than 1 yr 0 Negative 0