12About You3Loan Details4Confirmation This field is hidden when viewing the formLoan AmountThis field is hidden when viewing the formLoan MonthsThis field is hidden when viewing the formLoan RepaymentThis field is hidden when viewing the formTotal Repayable Apply for a Saver LoanYou are applying for a loan of at 4.5% APR over months. Your total monthly repayment will be This is for illustrative purposes only. Actual figures will be based on your personal circumstance, credit reference information and your ability to repay. This form should take about 5 minutes to complete Only complete this form if: You are a current member of London Mutual Credit Union You have savings equal to, or less than, the amount you are applying for. (if not, click here)The address displayed in your address bar begins with 'creditunion.co.uk' and a padlock icon is visible. About YouWhat is your name?* First Last What is your email address?* What is your membership number?Enter your London Mutual Credit Union Membership number, if you know it.What is your date of birth?* Day Month Year What is your home address?* Street Address Address Line 2 City Post Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Loan DetailsNow for a few questions about how you plan to use the loan, and how you would like to receive the money.Loan purposeWhat do you plan to use this loan for? This question is optional, but will help us to better understand how members use our loans.Home improvementDebt consolidationVehicle purchase or repairHousehold appliancesMoving houseHolidayMedical costsFamily event (wedding, funeral, new baby, birthday)Childcare depositRent depositRent arrearsTravel season ticketSchool uniformOther purpose (provide details below)Provide further details about how you will use the loanYou can enter up to 500 charactersHow would you like to receive your loan?* Into my Credit Union (CUCA) current account Into another bank account Details of the bank or building society account to pay the loan intoAccount Name*We can only pay loans into a bank or building society account which belongs to youAccount Number*Sort Code*This field is hidden when viewing the formEncashment FeeAn additional administration fee of will be charged for loans paid in cash. Confirmation Summary Loan amount Interest rate 4.5% APR Length months Monthly repayment I confirm that I have read and agree to:* Loan Terms & Conditions View Loan Terms & Conditions | Download Loan Terms & Conditions Privacy Policy View Privacy Policy | Download Privacy Policy Loan Declaration View Declaration | Download Fair Processing Notice Fair processing notice The personal information we have collected from you will be shared with fraud prevention agencies who will use it to prevent fraud and money-laundering and to verify your identity. If fraud is detected, you could be refused certain services, finance, or employment.For further details of how your information will be used by us and these fraud prevention agencies, and your data protection rights, visit creditunion.co.uk or ask in branch for the full Fair Processing Notice. By clicking "submit application" you are submitting your application for a loan. 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