Financial Hardship Application

Is this a joint application?

Yes

No

Reason for application

Provide specific details of your change of circumstance, along with your request for assistance.

Please advise what assistance you are looking for with this application

Payment holiday (Deferred payment)

Reduced payments

Interest only payments

Other - please specify

Primary applicant personal details

Member number

First name

Last name

Middle name(s)

Date of birth - please enter as: DD/MM/YYYY

Primary applicant contact details

Email address

Residential address

City

Post code

Best contact number

Name of present employer

Occupation

Employer's address

Privacy statement

I confirm that I am aware that when I press ‘next’, my personal information supplied will be stored by Unity in line with our Privacy Statement, even if I do not complete the rest of the application.

Please read our Privacy Statement here

Secondary applicant personal details

Member number

Last name

First name

Middle name(s)

Date of birth - please enter as: DD/MM/YYYY

Secondary applicant contact details

Residential address

City

Post code

Best contact number

Email

Occupation

Employer's address

Please enter in your financial details as based on a weekly basis.
If this is a joint application, please enter in the combined weekly amounts of both applicants.

Income (weekly)

Your net income (After tax)

Other income (including: board payments, working for families, tax credits, child support payments etc. Please specify)

Expenditure (weekly)

Mortgage/Rent/Board

Rates/Water

Living costs (Food, power, insurance, vehicle, telephone etc.)

Hire purchases

Credit cards

Loan/Overdraft

Assets

Superannuation fund (name and balance)

Other

I/We certify and acknowledge that:

All information supplied is true, correct and complete and may be relied upon by Unity.
I/we have not withheld any information (including information regarding bankruptcy, no asset procedure (NAP), or a Debt Repayment Order (Summary Instalment Order) which may affect Unity Credit Union’s decision regarding this application.
I/we will advise Unity of any changes to relevant personal information including (but not limited to) the information in this application.
Unity may use personal information it holds for the purposes set out in the General Terms and Conditions. This includes (but is limited to) provision of products or services by Unity, market research, legal compliance and promotion of products and services by selected third parties engaged by Unity.
Unity may (at its sole discretion) make relevant enquiries in relation to the application, including credit checks and enquiries in relation to my current or past employment.
My personal information may be disclosed to debt recovery and credit reporting agencies, and my personal information may be disclosed by credit reporting agencies to their eligible customers.
I/we have the right to access and correct any information held about me by Unity.
Unity will ensure that information about me is securely held and will not, except as set out in General Terms and Conditions or as authorised by me or when required or authorised by law, be disclosed to any other person or organisation.