Loan Form

Warning: This is a high-cost credit. Consider alternative options before applying for this credit, including alternatives from other lenders regulated by the Central Bank of Ireland.

Loan

Loan Type

Amount

Total Charges

Duration

APR

Std Collection

Repayable Ammount

Profile

Surname

Forename

Gender

DOB

You Must be 18 or Older to Apply this Loan

Phone #

Mobile #

EMail

PPSN

Address

Address2

Address3

County

EIR Code

Residence Status

Years at Address

Marital Status

Partner

# Children

# Non-Dep Children

Employment

Employment Status

Years Employed

Name

Address

Address2

Address3

County

Post Code

Income

Wages

FamilyAllow

Social Walfare Contribution

Social Member Contribution

OtherIncome

OtherIncome2

Expenditure

Rent

Finance

HouseholdExp

HouseKeeping

TV

Transport

Motor

Entertainment

Childcare

Taxes

Totals

Total Income

Total Expenditure

Total Disposible Income

Affordable Weekly Payment

Others

Bank Acccount

Have

Don't Have

Credit Card

Have

Don't Have

Permission

Your have my permission to visit my home from time to time to discuss personal loans

Registering / Reporting with a credit reference bureau should it be the Central Credit Register

Use of information about me and my accounts for crime prevention and detection

Visiting or phoning my family :

If I request,
If I am difficult to contact,
If they answer the door or phone when you call

Refering my account to your Debt Recovery Agency, if I am difficult to contact or default on my repayments

Use of the information about me and my accounts for market research and the marketing to me of credit and other products

You have my permission to call to me anytime between 8 AM to 10 AM.

I am interested in a cash loan. I understand that under the Consumer Credit Act, your staff can only discuss cash loans in my home if they receive a written request from me. Please send someone to my home to discuss a cash loan.

*As per-data protection law, we cannot take your public service card as proof of ID. Instead use passport or driving license, etc.

ID (Driver License/Paspor/ID)

What can it be?

Driver's license or;
European ID card or;
Passport

ID documents MUST:

Be in data
Contain a clear photograph
Contain full name
Contain date of birth
Be a complete, clear and fully legible copy
Include all 4 corners of the document

*Please upload a scanned copy or photo of your Passport or Driving Licence. Files uploaded should be no bigger than 4MB in size.

Proof of Address (From utility bill)

*Proof Of Address not more than 6 months old
What can it be?

Bank statement or;
A letter from a governmental body (i.e. tax authority or local authority)

Proof of Address documents MUST:

Be dated within 90 days;
Contain full name;
Contain current address;
Contain bank account number (in case of bank statement);
Be complete, clear and fully legible;

*Please upload a scanned copy or photo of your Proof of Address (From utility bill). Files uploaded should be no bigger than 4MB in size.

Income

*Proof Income not more than 2 months old
*Please upload a scanned copy or photo of your Income. Files uploaded should be no bigger than 4MB in size.

PPSI

*Please upload a scanned copy or photo of document that contains your PPS Number and your name. Files uploaded should be no bigger than 4MB in size.

Siganture

By signing this application, I certify all information is true and correct to the best of my knowledge.