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Full Name
Membership No
National Insurance Number
Your Email Address
Contact Tel No. 
Number of Children under 16
Youngest Childs Date of Birth
Top up Amount
Purpose for loan
Have any of your contact details changed since your last application, eg address?  
Please provide your new contact details:
Current Employment Status
If employed full or part time, please provide details of your employer including telephone number:
Has your income and expenditure has changed recently, since your last application or is it expected to in the near future
If yes, please provide details

Are you presently entering, or do you have a current Debt Relief Order, Individual Voluntary Arrangement or Debt Management Plan? 

Please use this section to provide any further details regarding your application for a ‘Top Up Loan’

Declaration - Important Please Read in Full
The information I have given is true and accurate, and I will notify West Cheshire Credit Union if any of the information changes before my loan is assessed for affordability.
  1. I agree to any appropriate credit checks and information vetting being undertaken to assist the West Cheshire Credit Union reach an informed decision regarding this application and understand that this may include employment checks and searches of credit reference agencies.
  2. I declare I am in good health, and I know of no good reason why I would be unable to carry out my usual work or why my benefits or other income may change during the term of the loan.
  3. I understand that I have a responsibility to make all my loan repayments on time and in full and I promise to do so.
  4. I understand that the savings in my share account(s) can be used to pay my loan if I miss a payment.
  5. I am aware that if I fail to meet continual repayments on my loan my details will be used for recovery purposes, which may also involve being passed to the Department of Work and Pensions for reasons to recover outstanding sums via the Eligible Loan Deduction Scheme (money deducted from your benefits)
  6. I confirm that West Cheshire Credit Union can use all the information in this application in the running of my credit union account(s) together with any other checks (including checking with licensed credit reference agencies) for assessing my application to avoid fraud and to recover any outstanding debts.

Which office do you wish to submit your application to?