Applicant’s declaration

1. I authorise you to obtain any information you may require relating to this application from my employer.

2. I undertake to notify the Cooperative immediately of any situation which materially changes the representation of this application.

3. I hereby authorise the Cooperative to disclose any and all information in respect of my account to the guarantor’s for as long as the guarantors’ liability of this debt outstands.

4. I hereby authorise the Cooperative to disclose any and all information in respect of my account to my current employer should a default occur, and remain outstanding beyond 30days.

5. I certify that information listed on this application is true and correct to the best of my knowledge.

6. I accept and agree to be bound by the terms and conditions as contained in the Bye-law.

Applicant’s Signature_____________________________  Date _____________________________