Progressive Credit Union Loan Application

Progressive Credit Union Co-operative Society Limited

Loan Application Form
LOAN INFORMATION
Application Date*

MonthDayYear
Date
I hereby apply for a loan of $*
Purpose of Loan*
Member Account Number
Date Joined Credit Union

MonthDayYear
Date

APPLICANT INFORMATION
Name*

First NameLast Name
Mother's Maiden Name
Member Number
Identification Number*
DP Number / Passport Number
Number of Dependents
Email Address*
example@example.com
Date of Birth*

MonthDayYear
Date
Home Phone Number
Please enter a valid phone number.
Mobile Phone Number*
Please enter a valid phone number.
Business Phone Number
Please enter a valid phone number.
Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Previous Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Length of stay at current address
Length of stay at previous address
Employment Income*
Name of Employer*
Employer Contact Number
Date of Employment

MonthDayYear
Date
Job Title*
Employee Number
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Retirement Date

MonthDayYear
Date
Other Income Amount
Source of Other Income
Previous Employer Name
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date

WHAT YOU OWE
Debt #1
Debt #2
Debt #3
Debt #4

MONTHLY EXPENDITURE
List your monthy expenditure. NAME and AMOUNT

WHAT YOU OWN
List of Assets / Collateral 1
List of Assets / Collateral 2
List of Assets / Collateral 3
List of Assets / Collateral 4

REFERENCES
Reference 1*

First NameLast Name
Reference 2*

First NameLast Name
Reference 1 Phone Number*
Please enter a valid phone number.
Reference 2 Phone Number*
Please enter a valid phone number.
Reference 1 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Reference 2 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Relationship to Applicant
Relationship to Applicant

MEMBER INFORMATION CHECKLIST
PRIMARY ID: Please upload a copy of your ID*

Cancelof
SECONDARY ID: Please upload a copy of your Passport or Drivers Permit*

Cancelof
Please upload proof of address. Copy of Utility Bill. No more than 3 months old. *

Cancelof
Please upload job letter *

Cancelof
Please upload recent payslip*

Cancelof
I am not indebted to any other Credit Union, Bank or Loan Agency, either as a borrower, co-maker, or guarantor, except as stated above.The statements herein are made for the purpose of obtaining the loan and are true and correct to the best of my knowledge and belief.
Applicant's Signature - Enter your name in block letters.
Date

DayMonthYear
Date
Should be Empty: