Loan Request Form | Bethel Credit Union

Branch *Head Office - #31 Bethlehem Road, BethelMt. Marie Branch - Mt. Marie, Lower Scarborough

Account Number *Note: Your Account number is the six digit number found after " / " i.e. No. B01C012 / 001234

Prefix

First Name *

Last Name *

Date of Birth *

Day

Month

Year

Contact Number

Email Address *

Residential Address

Region

Country

Amount Requested *

Payment Method *

Purpose of Loan

Note: You are required to provide two (2) form of identification.

Type of Identification *You are required to select a unique form of identification.

ID Number *

Upload PDF Copy of Identification *

No file chosen

Note: Only PDF files can be uploaded.

Type of Identification *You are required to select a unique form of identification.

ID Number *

Upload PDF Copy of Identification *

No file chosen

Note: Only PDF files can be uploaded.

Declaration

I/We hereby authorize you to obtain further information on my/our credit and employment history and such source is hereby authorized to disclose any Credit Bureau and together credit grantors and information about my/our credit history. I/we agree to indemnify you jointly and Severally against any and all claims in damages or otherwise arising from disclosure on your part.

If the loan is granted, I hereby agree to comply with all the terms, bye-laws, and regulations of the society, now in force or which may hereafter be adopted. The statements herein are made for the purpose of obtaining the loan and are true and correct to the best of my knowledge and belief.

Note: Once a credit report is generated you would be charged a fee of $100.00 .