CBC Credit Union

Date:	New Money Requested $
Purpose:

Type of Loan:
Regular Loan PLC/Overdraft Demand Mortgage Other

Applicant

Account #

Name:

Address:

City:

Postal Code:

Marital Status: Married Single

# of Dependants:

S.I.N. #:	Date of Birth:
Home Phone:	Work Phone:

Employer:

Address:

Position Held:

# of Years:

Annual Salary:

Other Income/Rental:

Other Income:

Co-Applicant

Account #

Name:

Address:

City:

Postal Code:

Marital Status: Married Single

# of Dependants:

S.I.N. #:	Date of Birth:
Home Phone:	Work Phone:

Employer:

Address:

Position Held:

# of Years:

Annual Salary:

Other Income/Rental:

Other Income:

Creditor/Description - List what you own and owe !

Mortgage / Rent:

Asset (value):	Liability (owe):
Monthly Payments:	Annual Payments:

Other Property:

Asset (value):	Liability (owe):
Monthly Payments:	Annual Payments:

Vehicles:

Asset (value):	Liability (owe):
Monthly Payments:	Annual Payments:

Other Vehicles:

Asset (value):	Liability (owe):
Monthly Payments:	Annual Payments:

RRSP / Stocks:

Asset (value):	Liability (owe):
Monthly Payments:	Annual Payments:

Bonds / Cash:

Asset (value):	Liability (owe):
Monthly Payments:	Annual Payments:

Personal Loans:

Asset (value):	Liability (owe):
Monthly Payments:	Annual Payments:

Other:

Asset (value):	Liability (owe):
Monthly Payments:	Annual Payments:

Credit Cards / Limit:

Asset (value):	Liability (owe):
Monthly Payments:	Annual Payments:

"Upon submission of this application, I hereby certify that all statements made, are true and complete and submitted for the purpose of obtaining credit, and, I hereby consent that the credit union prepare and/or cause to be prepared a consumer report, and/or share information with other credit granters or agencies for the purpose of obtaining credit."