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

I Confirm :

That I do notsuffer from any impairment that would make it difficult for me to make my own financial decisions.

That I initiated contact with the lender and the lender did not make unsolicited contact with me

That I requested this credit and it was not offered to me before I requested it.

That I am not a Politically Exposed Person(PEP) & I understand what a PEP is.

I give you permision:

To perform credit checks and provide data about me to the Central Credit Register.

To make unsolicited contact with me for 12 months from the date of this contract

To include me in marketing surveys and promotions.

I understand:

That if I get overindebted I should contact the company first to discuss my financial situation.
If no resolution is forthcoming I should then contact my local MABS office on lo-call 0761- 07200.

That if I select Electric Documentation I must access all documents relating to this agreement electronically.

That the information on this form, which I certify to be correct & complete, will be held by the company.

*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.

Signature

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