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[" LOAN APPLICATION FORM   "]
[]
["This form must be completed in full prior to submission, failure to do so it will result in this application "]
["being returned to you and delay a decision.  Please ensure that you enclose the 2 most recent "]
["banks statements for all accounts that you hold and wage slips with this applications.  "]
["Please note that if you are dependant on benefits as your only source of income then the maximum "]
["loan amount that can be considered is £650."]
["1. ABOUT YOU"]
[]
["Title",null,null,null,"Forename",null,null,null,null,"Surname"]
[]
["Date of Birth",null,null,null,null,null,null,null,"Membership Number"]
[]
["Address"]
[]
[null,null,null,null,null,null,null,null,null,"Postcode"]
[]
["Length of Residence",null,null,null,null,"  Contact No"]
[]
["Residential Status",null,null,null,"Home Owner",null,null,"Private Tenant",null,null,null,"Living with Parents"]
[null,null,null,null,"Housing Association",null,null,"Name of Housing Ass. "]
[]
[null,null,null,null,"Other","(Please state)"]
["Previous Address (If less than 3 years at current)"]
[]
[]
[]
["Email"]
[]
["National Insurance Number"]
[]
["2. EMPLOYMENT DETAILS"]
["Employment status",null,null,null,"Employed",null,"Self Employed",null,"Unemployed",null,null,"Retired",null,"Other"]
[null,null,null,null,"Full Time ",null,null,"Part Time",null,"      No of Hours per week"]
[null,null,null,null,"Temporary",null,null,"Permenant"]
["Employer"]
[]
["Place of Work"]
[]
["Work Tel Number",null,null,null,null,null,null,null,"Length of Service"]
[]
["Position"]
[]
["3. LOAN REQUEST DETAILS"]
[]
["Loan type requested",null,null,null,null,null,"Saver Loan",null,null,"Child Benefit/Family Loan"]
[]
["Amount Requested",null,null,null,null,null,"Purpose of Loan"]
["Repayment Method",null,null,null,null,"Cash",null,"Standing Order",null,null,null,"Payroll","   Child Benefit"]
["If applying for a Child Benefit Loan please complete the following"]
["Child Benefit number",null,null,null,null,null,null,null,null,"Paid",null,"weekly","   4 weekly"]
[]
["No of Children under 16",null,null,null,null,null,"Ages",null,null,"Youngest child DOB"]
[]
["4. CREDIT HISTORY"]
[]
["Are you in arrears with your Rent/Council Tax/Utilities/Mortgage?"]
[]
["Have you missed any payments to creditors in the last 12 months"]
[]
["Are you or have you ever been or are you applying for Bankruptcy / Debt Relief Order "]
["/ IVA / Debt Management Plan / County Court Judgement"]
[]
["If you have answered yes to any of the above please provide details here:"]
[]
[]
[]
[]
["5. INCOME & EXPENDITURE"]
["Income"]
[null,null,null,null,null,"Weekly",null,"Fortnightly",null,"4 Weekly",null,"Monthly"]
["Wages/ Salary"]
["Working Tax Credit"]
["JSA / ESA"]
["Housing Benefit"]
["Council Tax Benefit"]
["Income Support"]
["Child Benefit"]
["Child Tax Credit "]
["Pension / Pension Credit"]
["DLA / PIP"]
["Maintenance"]
["Carers Allowance"]
["Universal Credit"]
["Other Income"]
[]
[]
[]
[]
["Expenditure",null,null,null,null,"Weekly",null,"Fortnightly",null,"4 Weekly",null,"Monthly"]
["Mortgage/Rent you pay"]
["Council Tax you pay"]
["Insurance/House/Pet/life"]
["Vehicle Costs/Petrol/Ins"]
["Water"]
["Gas/Electric"]
["Food & Toiletries"]
["Travel Costs/bus/taxi"]
["Clothing"]
["TV Licence"]
["Satellite/Internet"]
["Landline/Mobile"]
["Childcare Costs"]
["Other"]
[]
[]
[]
["Existing Credit Commitments"]
[null,null,null,null,null,"Weekly",null,"Fortnightly",null,"4 Weekly",null,"Monthly"]
["Loan Repayments"]
["Credit/Store cards"]
["Brighthouse"]
["Provident"]
["Other"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
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[null,null,"   I confirm that the above declaration be correct in relation to this application"]
[]
["Name",null,null,null,null,null,null,null,null,"Date   "]
[]
["Please save this file and send via email as an attachment together with your bank statements, wage slips, "]
["Universal Credit Statement etc to one of the following offices; "]
["ep@wccu.co.uk ",null,null,null,"     For our Ellesmere Port Office"]
["info@wccu.co.uk",null,null,null,"     For our Chester Office"]