PLEASE NOTE: This is a 'SINGLE LOAN' application form.
To apply for a JOINT LOAN please use this form
If you are not a member you should contact our Administration Office on 059 9721000 or visit our website at Leighlin Credit Union

Please fully complete the form below.


If you have lived at your current address for less than 3 years please provide details below


Please tell us about your main source of income

If you are employed, please provide your employers name and address

If you are unemployed, please provide details of the main benefit you receive

  Where I have indicated I am employed, I confirm that I am in a permanent contract and not under notice of redundancy or termination of employment.  

Please provide any outstanding balances and monthly payments of the following:

Supporting documents

To proceed with your application we require some supporting documents. These are:
3 payslips / social welfare payment slips (note – only required if salary / social welfare payment is NOT paid into Bank Account)
3 months bank statements covering the latest 3 month period
Quote for any home improvements work over €20,000
Please upload these documents using the upload facility below. Documents should be in picture (jpeg) or pdf format

bank details

To have your loan payment sent to your bank account, please provide bank details below


Important Your Personal Information: Credit decisions and also the prevention of fraud and money laundering.

We may use credit reference and fraud prevention agencies to help us make decisions. What we do and how both we and credit reference and fraud prevention agencies will use your information is detailed in

A Guide to the use of your personal information by ourselves and at Credit Reference and Fraud Prevention Agencies

or you can call our Administration Office on 059 9721000 for a copy.

By confirming your agreement to proceed you are accepting that we may each use your information in this way.

  In making this application, I confirm I am not a bankrupt, involved in an Individual Voluntary Arrangement, Debt Relief Order or in agreements with creditors for reduced payments or have plans to be. * 
  I accept the use of Credit Reference Agencies and declare that the information given by me on this form is true and correct, to the best of my belief. * 
  I consent to my personal data being held by Leighlin Credit Union Ltd for the purposes of this application and my membership with the credit union. * 
  The information provided by me on this form is supplied for the purpose of obtaining a loan, and is to true to the best of my knowledge and belief * 
  I confirm I am fit to follow my normal occupation or duties * 
  I hereby apply for this loan * 

To complete your application please ensure your e-mail address is correct and then select Apply below.