Provincial Credit Union Prsonal Loan Application

Provincial Credit Union

Provincial Credit Union
281 University Ave. Charlottetown, PE C1A 4M3
Stratford Branch, 10 Kinlock Road, Stratford, PE C1B 1R1
Stella Maris Branch, 7201 Main Street, Box 130 North Rustico, PE C0A 1X0
Montague Branch, 524 Main Street, Box 760, Montague, PE C0A 1R0
Phone: 902-892-4107

* = REQUIRED FIELDS

Loan Information
Application Type: Mortgage Personal Loan Line Of Credit RRSP Loan Credit Card Loan Energy Efficient Loan
Requested Amount		Term		Amortization (Mortgage Loans Only)

MORTGAGE CALCULATOR		LOANS CALCULATOR

Personal Information
Last Name *
First Name *
Middle Name
Birth date *
SIN *
Address - Street *
City *
Province *
Postal Code *
How long at this address (yrs)
Previous Address (if at current address less than 2 yrs)
Primary Phone # *
Secondary Phone #
Email Address *
Preferred Method of Contact (i.e. email, telephone, work, home, cell)
Are you a Member? Yes No
Shares	$
Marital Status: * Single Married Common Law Separated/Divorced
# of Dependants *

Co-Applicant Personal Information
Last Name
First Name
Middle Name
Birth date
SIN
Same Address as Buyer? Yes No
Address - Street
City
Province
Postal Code
How long at this address (yrs)
Previous Address (if at current address less than 2 yrs)
Marital Status: Single Married Common Law Separated/Divorced

Buyer Employment & Income
Employer *
Employer Phone*	ext
Employers Complete Physical Address Including postal code *
How long have you been working there? (yrs)*
Employment Status*
Employment Type (please complete if above answer is Other-Undergraduate(University) or Other-Graduate(Masters/PHD)
Occupation / Position *
Gross Income (Monthly)*
Additional Income (Monthly)
Identify Source for Additional Income
If Other please Specify
Previous employer (if less than 2 years in current position)
How long were you there for? (yrs)
Occupation / Position

Co-Applicant Employment & Income
Employer
Employer Phone	ext
Employers Complete Physical Address Including postal code
How long have you been working there? (yrs)
Employment Status
Employment Type (please complete if above answer is Other-Undergraduate(University) or Other-Graduate(Masters/PHD)
Occupation / Position
Gross Income (Monthly)
Previous employer (if less than 2 years in current position)
How long were you there for? (yrs)
Occupation / Position

Buyer Financial Information
Housing Status Rent Own
Mortgagor or Landlord?
Estimated Property Value
Estimated Mortgage Balance
Rent/Motgage (PIT) Payment (Monthly)*
Support Payments (Monthly)

Other Debt and/or Expenses examples (Credit Cards, Loans, Extra Mortgage)
Other Debt	Balance	Description

Assets examples (House, Investments, RRSP's savings, cars, cottage)
Value	Description

PAP Information
Financial Institution		Branch Address
Bank Id.		Transit No.		Account # from which payments will be made
NOTE *Attach a void cheque *

Will this loan be used by or on behalf of a third party? No Yes (If "Yes" is selected please complete and attach a Third Party Determination form.)

		Buyer	Co-Buyer
Have you ever been?	Bankrupt *	Yes No	Yes No
		Date:	Date:
	Orderly Payment of Debts	Yes No	Yes No
Are you now or do you anticipate being involved in litigation?		Yes No	Yes No

Personal Reference
Full Name: *		Phone #: *		Relationship: *
Full Address: *

Full Name: *		Phone #: *		Relationship: *
Full Address: *

Branch

Reason For the Loan *


If I/we choose to provide the Credit Union with my/our Social Insurance Number(s), I/we authorize the Credit Union to use it for verifying and reporting credit information to credit bureaus and credit reporting agencies. I/We understand that I/we may refuse to consent to its use or disclosure for these purposes. This consent and authorization is provided on the condition that the Credit Union is in compliance with any applicable legislation, including the Personal Information Protection and Electronic Documents Act (Canada). I/We understand that I/we may obtain more information regarding the Credit Union's commitment to protecting my/our privacy including my/our right to limit or withdraw my/our consent and authorization respecting my/our Personal Information by reviewing the Credit Union's Privacy Code, which will be provided to me/us at my/our request. I/We hereby certify that all statements made in this credit application are true and complete and submitted for the purpose of obtaining credit.