Temporary Loan Arrangement Request Form

Personal Details

Account Number

Address

Contact number

Email

Date of Birth (dd/mm/yyy)

Employment Details

Employer

Role

Industry
---HospitalityRetailChildcareConstructionEducationHealthcareFinancial ServicesManufacturingI.T./Digital ServicesPublic SectorAutomotiveOther (please state)
Other Industry

Temporary Loan Arrangement Reason

Loan Repayment Details

New Income Amount

Source of income

Previous Loan Repayment Amount

Proposed Loan Repayment Amount

Mandatory acknowledgements required

I acknowledge that St. Canice’s Credit Union will require one of the following supporting documents to fully consider my request; YesNo
Such as:

• Letter from employer outlining change in employment circumstances as a result of COVID-19
• Copy of application for COVID-19 Pandemic Unemployment Payment
• Copy of approval for COVID-19 Pandemic Unemployment Payment
• Copy 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