FOND ST JACQUES CREDIT CO-OPERATIVE SOCIETY LTD

LOAN APPLICATION FORM

(To be completed by Loans Officer)


Section I


Format: 1758-555-5555

Format: 1758-555-5555

Format: 1758-555-5555
Years

Existing Loans Information (To be completed by Loans Officer)

Loan 1.
Balance $
Current Monthly Payment $
Loan 2.
Balance $
Current Monthly Payment $
Loan 3.
Balance $
Current Monthly Payment $
Total Loan Balance $
Total Monthly Repayment $
months

LOAN AGREEMENT (To be completed by Loans Officer)

For value received, I/we the undersigned, waiving our rights of demand and notice, jointly and severally promise to pay the Fond St Jacques Credit Cooperative Society Limited (herein after referred to as the Credit Union) the sum of $ ……………………………………… with interest at the rate of ………………………………. percent per month on the unpaid balance, the first payment of $ ………………………………………. to be made commencing the month of ………………………………………… 20 ___ and an equal amount every month/fortnight/week thereafter until the full amount is paid.

Upon default of payment of any instalment of this note or in the event the money borrowed on this note is not used for the purpose set forth in this application, or in the case of any misrepresentation or misstatement made by the borrower or co-maker in obtaining the loan or in case the holder shall deem the security thereof unsafe for any reason whatsoever, then this note, or so much hereof as may remain unpaid, shall at the option of the holder immediately become due and payable. In the event of default, the maker or makers hereof pledge any shares, deposits, now or hereafter held by them in this Credit Union as security, additional or otherwise, for the payment of this obligation. I/we hereby authorise(s) the Treasurer to apply any or all such shares, deposits or dividends, to the payment of this loan, interest, cost or expense.

Also if the holder thereof after default shall place this note in the hand of its solicitors (or licensed collection agency) for collection, the undersigned agree(s) to pay an additional sum as a fee for collection equal to twenty-five percent of the entire obligation, which may remain due and unpaid after there has been credited to the maker, the amount of his or her share account in this institution and after there has been applied any reductions such sums if any as may be realised from the sale of any other security in the possession of the Credit Union, which is being held as collateral against any loan. Such charge for collection in no event is to be less than five dollars.

Signatures

Witness: ____________________________

Maker: ______________________________

Date: _______________________________

Date: _______________________________

Witness: ____________________________

Co-maker: ___________________________

Date: _______________________________

Date: _______________________________

Section II MONTHLY BUDGET ANALYSIS

(To be completed by Applicant)

INCOME

$

OFFICE USE ONLY

  1. Gross Monthly Income
  1. Less P A Y E
  1. Less N I C
  1. Net Income
  1. Spouse's Income
  1. Less P A Y E
  1. Less N I C
  1. Net Income
  1. Other Income

(4+8+9) Net Income

EXPENDITURE - BOARDING AND LODGING

  1. Rents Rates and Taxes
  1. Insurance - Building
  1. Insurance - Furniture and Appliances
  1. Repairs and Maintenance
  1. Electricity
  1. Telephone
  1. Water
  1. Other

(10 to 17) TOTAL

LIVING EXPENSES

  1. Food
  1. Clothing
  1. Medical
  1. Life Insurance Premium
  1. Medical and other Insurance
  1. Entertainment/Social/Clud Dues
  1. Other

(18 to 24) TOTAL

TRANSPORTATION

  1. Car Hire, Rentals e.t.c.
  1. Public Transport
  1. Motor Vehicle License
  1. Motor Vehicle Insurance
  1. Motor Vehicle Operating Cost

(25 to 29) TOTAL

FINANCIAL OBLIGATIONS

  1. Mortgage Instalments
  1. Motor Vehicle Loan Instalments
  1. Furniture or Appliances
  1. Other Loan Instalments
  1. Other Financial Obligations
  1. Education
  1. Professional Fees/Dues
  1. Subscriptions
  1. Monthly Commitment to Savings

(30 to 38) TOTAL

BUDGET ANALYSIS SUMMARY

Lines 1 to 9

Net Income

Lines 10 to 38

Less Monthly Expenditure

Net Surplus (Deficit)

Proposed Repayment

Surplus (Deficit)

Debt Service Ratio

%

No. of persons dependent on member and spouse's income

The foregoing Monthly Budget Analysis of the undersigned is hereby declared to be correct and it is agreed that any advances made to the undersigned by the Fond St Jacques Credit Cooperative Society Limited are on the strength of this statement.

Signature:__________________________________

Date:_________________________________

Monthly Indebtedness to Financial Institution (to be completed by Applicant)

Institution Reason for Debt Date Incurred Amount Balance Owing Monthly Repayment Status

Attestation

I declare that I am not indebted to any Credit Union, Bank or financial institution either as Marker, Co-maker or Guarantor except as stated on this form.

I hereby witness and confirm that the foregoing statements are true and correct and have been made by me knowing that you will place reliance on them when considering my application.

You are hereby authorised to obtain any information you may require relating to this application from any source, which you may apply and each such source is hereby authorized to provide you with such information. I undertake to notify the Credit Union immediately of any situation, which materially changes the representation made in the application for the loan.

Witness: _______________________________

Signature of Witness: _______________________________

Attached Documents:

Section III

Co-maker's Information


Format: 1758-555-5555

Format: 1758-555-5555

Format: 1758-555-5555
Years

Signature of Co-maker: ____________________________

Date: ______________________________


Section IV

LIEN OVER SHARE BALANCE HELD AS COLLATERAL

  1. The undersigned hereby authorize FOND ST. JACQUES CREDIT CO-OPERATIVE SOCIETY LIMITED To hold the sum of ………………………………………………………………………………………………………………………...... ($ ............................ ) which is part of/ the full/ Share Balance on my account #................................ as Collateral for Loan in the name of ………………………………………………………………………………............................………………………………………………
  2. In the event of any default in such payment to the loan, without notice to the undersigned, the Credit Union will withdraw the said sum from the Share Balance to meet the Loan obligations.
  3. At its discretion, from time to time, the Credit Union may allow the undersigned to withdraw from Share Balance of the said account if this is in excess of indebtedness balance.

Signed at …………………..........……… the …...…… day of ……….............…….. 20........

__________________________________

_________________________________

Print Name

Signature

__________________________________

_________________________________

Print Name

Signature

__________________________________

_________________________________

Print Name

Signature of Witness

Section V

COMMENTS OF LOAN OFFICER/MANAGER

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_________________________________

Signature


Decision by Manager/Loan's Officer on behalf of Credit Committee($5000 or less)

Section VI: Decision of the Credit Committee

Signatures of Credit Committee (Please affix initials next to signatures)

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Section VII: Decision of Board of Directors/Joint Committee

Signatures of BOD/Joint Committee (Please affix initials next to signatures)

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On ………………………20 __ __ we approved a loan in the amount of $ ………………....... on the conditions agreed by the named applicant except as follows (list any changes in amount, terms or conditions)

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Date loan application was considered: __ __/__ __/ 20 __ __


Section VIII
(For office use only)

(to be completed by Teller)

Signature of authorised persons: ____________________________

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