SVG TEACHERS CO-OPERATIVE CREDIT UNION LTD – REVOLVING LOAN APPLICATION

NAME: ACCOUNT #:

5. REQUEST Branch: Kingstown Other_____________________

AMOUNT REQUESTED: $_____________________

Rate: ____% per month Duration: ______ Months Payment: $_________

6. CONFORMITY WITH REGISTRATION FORM (Fill a new REG form if Yes to first two questions)
The Member’s address is the same as the Registration Form? Yes No
The Member’s occupation is the same as the Registration Form? Yes No
The Member’s status and Spouse Occupation are the same as the Registration Form? Yes No
The Member’s shares add to Co-maker’s shares cover 100% of the loan? Yes No

7. BORROWER'S FINANCIAL STATUS

Monthly Income
Borrower’s Gross Income
Spouse’s wages (for information)
Other family income (itemized)
Amount/Month Monthly Disbursements Amount/Month
Rent/ mortgage/ pension
Food, Transportation,
Electricity, water, telephone, mobile, Cable
NIS, Income Tax, Union dues
School fees, Allowances
Clothing, Medical care, Insurance
Other expenses: hire Purchase
Other Loan payments SVUTCCU
Other Loan payments

TOTAL GROSS INCOME (A) TOTAL EXPENSES (B)

BUDGET SURPLUS (C) (income - expenses)

8. PERSONAL BALANCE SHEET

ASSETS LIABILITIES
Savings & Shares in SVUTCCU Loans in SVUTCCU

Savings in Banks :(Where) Loans in other Banks: (Where)

Savings & Shares in CU (Where) Loans in other CU: (Where)

Furniture/appliances Due: Water, Mobil, Hydro

Autos: Model: Year: Hire Purchase, Credit Card, other: (Where) Past

Land House Mortgage, Taxes

Other: Co-Maker for someone

TOTAL ASSETS TOTAL LIABILITIES

NET WORTH: (Total Assets Less Total Liabilities):

I solemnly swear that all the information provided on this document are true and correct and I authorize
SVUTCCU LTD to do any verifications it deems useful in order analyze my loan application. I am not indebted
to any other credit union, bank or hire purchase, either as maker or endorser, except as shown. In witness
whereof, I have signed:

______________ ___________________________________ __________________________________________

Date Loan Applicant’s signature Loan Officer’s signature