NBTA Credit Union

The Educated Choice

Products and Services

LOAN APPLICATION: Please fully complete the following application and contact us to discuss your loan. If you require information in completing this application, please bring the application with you to complete or contact us.

Acct #:

Please fully complete

Date:

Last Name	First Name:	Second Name:
No. of Years Teaching:	Social Insurance Number:	Date of Birth (DD/MM/YY):
Professional Number:	Marital Status:	Teaching License:
Spouse/Co-Applicant
Last Name:	First Name:	Second Name:
Professional Number:	Date of Birth (DD/MM/YY):	Social Insurance Number:
Teaching License:	No. of Years Teaching:
Personal Information
Present Address:	Mailing Address if different:	How Long:
City/Town:	Province:	Postal Code:
Present Employer:	Name of School:	Bus Phone:
		Home Phone:
Spouse's Occupation:	Name of School or Employer:	Business Phone:
Applicants Gross Income:	Spouse's Gross Income:	Other Income:
Email Address
Cash Requirements
Purpose:	Amount Required:	Collateral:
Term Requested

Creditors (Include all Lease Payments)
Name:	Payment	Balance

Monthly Gross	Mortgage/Rent	Heat
Lights	Child Support	Outstanding Income Tax
Outstanding Property Tax

STATEMENT OF NET WORTH

ASSETS

Home
Other

Auto

Make / Model

Value

Cash on Hand

Have you ever been bankrupt? Yes No Year Where

Are there any judgements against you? Yes No Amount

Have you ever gone through Orderly Payment of Debts? Yes No Year Where

Have you ever been sued for any debt? Yes No

Are you a co-maker, endorser or guarantor of anyone? Yes No

If "yes" who? How Much? Payment

Personal References
Closest Living Relative		Name & Address
Closest Living Relative (2)		Name & Address

I hereby certify that all statements made, are true and complete and submitted for the purpose of obtaining credit, and I hereby consent that the credit union prepare and/or cause to be prepared a consumer report.
Date	Signature of Witness	Signature of Applicant
Date	Signature of Witness	Signature of Applicant