Loan application
Note: ALL fields marked with an "*" are mandatory.
Membership number: *
Full name: *
Loan value: *
Repayment frequency: *
Repayment value: *
Loan purpose: *
If other: please state:
Address details
House/Flat number and street name: *
Address Line 2: *
City/Town: *
Post code: *
Home status: *
Time at address: years * months *
Additional details
Home telephone:
Mobile telephone:
Email address: *
Dependants: *
Work details
Are you currently employed: *
Income frequency: *
Salary/Wage: *
Partners income: *
Benefits: *
Pension: *
Total income:
Expenditure frequency: *
Rent/Mortgage: *
Council Tax: *
Electricity: *
Gas: *
Telecommunications: *
Groceries / Food: *
Catalogues: *
Credit card(s) / Store card(s): *
Hire purchase: *
Car loan: *
Other loan(s): *
Fares/Petrol: *
Clothing: *
Pension: *
Savings / Investments: *
Home insurance: *
Car insurance: *
Life assurance: *
Entertainment: *
Total expenditure:
Disbursement details
Disbursement method: *
* Payments into a building society require you to quote your roll number otherwise the payment will be rejected.

Credit references and use of your information
To help us make a decision on your loan application we will contact Credit Referencing & Fraud Prevention Agencies. This will register a search against your credit record and if your application is successful we will share the information we hold for you with these agencies. If fraud is detected, you could be refused certain services, finance, or employment.
Further details information about how you information is stored and used is provided in our Privacy Policy []. It is important your read this before applying

I confirm that the information given is true and complete to the best of my knowledge and belief. I also authorise you to make any credit reference checks and other enquiries in accordance with your procedures in connection with this application. I agree that the information obtained about me as a consequence of this and / or any other application and agreement which I have made with the Credit Union may be held on computer. I will not discuss or disclose details of my dealings with the credit union with / to any other parties.

Authorised by the Prudential Regulation Authority and Regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Registration Number 213743.

* Please note - Any loan applications may be subject to a credit reference agency search.

Contact details
Preferred means of telephone contact: *
To help prevent spam, using only numbers, what is 5 + 2: *
"Submitting this form is my agreement that LCCU may contact me by email concerning LCCU business."