Personal DetailsNameAccount Number Address Contact number Email Date of Birth (dd/mm/yyy) Employment DetailsEmployer Role Industry ---HospitalityRetailChildcareConstructionEducationHealthcareFinancial ServicesManufacturingI.T./Digital ServicesPublic SectorAutomotiveOther (please state) Other Industry Temporary Loan Arrangement ReasonLoss of EmploymentReduced hoursOther (please state) Loan Repayment DetailsNew Income Amount Source of income This income is receivedmonthlyfortnightlyweeklyPrevious Loan Repayment Amount Proposed Loan Repayment Amount Previous Loan Repayment FrequencymonthlyfortnightlyweeklyProposed Loan Repayment Frequencymonthlyfortnightlyweekly Mandatory acknowledgements required I acknowledge that St. Canice’s Credit Union will require one of the following supporting documents to fully consider my request; YesNoSuch as:Letter from employer outlining change in employment circumstances as a result of COVID-19Copy of application for COVID-19 Pandemic Unemployment PaymentCopy of approval for COVID-19 Pandemic Unemployment PaymentCopy of P45; COVID-19 Unemployment Payment I understand and acknowledge that the arrangement, if approved, will be temporary and will start and finish on the specified dates agreed in writing with St. Canice’s Credit Union. YesNo I understand and acknowledge that my original Credit Agreement will be amended temporarily for the time period that will be specified in writing and my original Credit Agreement will be re-instated on the date this temporary arrangement ends. YesNo I understand that it is my responsibility to amend the payments to my loan account for the duration of the arrangement period. Any extra funds transferred during the arrangement period will not be reimbursed to me. YesNo I agree to the terms and conditions for access to and use of the St. Canice’s Credit Union website and web forms and to the processing of my data, which may include sensitive data, for the purposes of reviewing this application in accordance with the Privacy Notice. YesNo