ACU – GRAIN - Agricola Credit Union Co-operative Society Limited

Basic Member Info

Name

Account Number

Home Address

Mailing Address

Branch
Port Of Spain Tobago Arima Marabella

Loan Type
ORDINARY LOAN PAYDAY LOAN VACATION LOAN JUMP-START LOAN

Cell Number

email Address

Personal Data

DOB

Age

Marital Status
Single Married Common Law Divorced Separated Widowed

Identification Choose a file

Max. size: 128.0 MB

Number of dependents

Reference 1 Name

Reference 1 Address

Reference 1 Cell Number

Reference 2 Name

Reference 2 Address

Reference 2 Cell Number

Purpose of Loan

Loan Purpose

Loan Justification Choose a file

Max. size: 128.0 MB

Employment

Employer Name

Employer Address

Employment Status
Permanent Temporary Monthly Month to Month Casual Self Employed Contract

Position

Years with Employer

Payroll paid at

Assets

Total Value

Supporting Documentation Choose a file

Max. size: 128.0 MB

Liabilities

Loans TOTAL VALUE

Monthly Payments TOTAL VALUE

Supporting Documents Choose a file

Max. size: 128.0 MB

Income Information

Total Monthly Income of Applicant(s)

Total Monthly Expenses of Applicant(s)

Supporting Documents Choose a file

Max. size: 128.0 MB

Affirmation

I/We warrant and confirm the information given herein is true and correct and I/we understand it is being used to determine my/our credit responsibility. I/We further confirm that no information which might affect the Credit Union’s decision to make a loan has been withheld. I/We hereby authorize and consent to the Credit Union receiving and exchanging any financial and other information which it may have in its possession about me/us with any subsidiaries, agents, third party assignees, other financial institutions, Credit Bureaus or other person or Corporation or with whom I/We may have or propose to have financial dealings from time to time. I/We indemnify the Credit Union against any loss, claims, damages, liabilities, actions and proceedings, legal or other expense which may directly and reasonably incurred as a consequence of the disclosure of information. My/Our deposit account may be charged with the monthly payments as they mature and I/We agree to pay your customary assessment for any notices of overdue installments

I confirm that the information provided is accurate and complete. I understand it will be used to assess my creditworthiness and authorize the Credit Union to obtain, share, and verify financial information with relevant parties, including subsidiaries, agents, credit bureaus, and other financial institutions. I agree to indemnify the Credit Union against any claims or losses arising from such disclosures. I also consent to monthly payments being charged to my deposit account and agree to pay any applicable fees for overdue notices.
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