Public Workers'Co-operative Credit Union Limited

Loan Application Form

Personal Information

Employment Information

Financial Information

PWCCU savings

Account Name Balance
Regular Shares
Qualifying Shares
Fixed Deposits
Collateral (Value Held)

PWCCU loans

Loan Id. Purpose Balance
Credit Card Credit Hold

Assets and Liabilities

Assets Description Value
Liability Creditor Payment Balance

Total Debt Service Ratio (TDSR) Calculation

Income Amount
Tips & Gratuities(75%)
Rental Income (50%)-$1,500.00
Business Income(50%)
Total Income
Expenses Amount
Total Loan / Credit Card Payments
Total Utilities
Total Household
Total Rent / Mortgage
Total Expense
I hereby agree to allow PWCCU Limited the right to contact and investigate any and all aspect of this application. I understand that as a part of the interview process, since I am applying for credit, PWCCU Limited requires me to disclose all information pertinent to the processing of this application. I authorize PWCCU Limited to use any and all information acquired to make decisions regarding my application. I understand and agree that if any material facts are discovered which differ from those facts stated by me on my application, credit may not be approved. I hereby indemnify, release and forever discharge and hold PWCCU Limited and employees, as well as all third parties supplying such information, harmless from any and all claims, demands, judgments and legal fees, arising out of or in connection with this investigation, the results, or any lawful use of the results or disclosure thereto.



Applicant's signature