PLEASE NOTE: This is a 'MEMBERS ONLY' loan application form. If you are not a member please join us by clicking Become a Member and completing the online application form or call us on 01 283 1034

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. * 
Your spouse or partner

Please provide any monthly payments of the following:

Supporting documents

To proceed with your application we require some supporting documents. These are:
3 months of payslips covering the latest 3 month period
6 months bank statements covering the latest 6 month period
Quote for any home improvements work
Please upload these documents using the upload facility below. Documents should be in picture (jpeg) or pdf format


As part of improving our service to you, from time to time, we would like to inform you of goods. services, competitions and/or promotional offers available from us. We may wish to use different means when sending such marketing communications. Please now indicate by which methods, if any, you consent to being contacted by selecting each method of communication below

  Email Marketing
  Landline Call Marketing
  Mobile Call Marketing
  Post Marketing
  Text Marketing

Receipt of obligatory notices by email:

There are certain notices that credit unions are obliged to provide from time to time. If you would like to receive these obligatory, non-marketing communications by email (for example, notice of the Annual General Meeting). This will assist Credit Union in reducing its carbon footprint and will reduce costs. Please note that we maintain the right to contact members by such means as best available to us in relation to nonperforming loan or outstanding debt to the credit union, updating personal data, including by text or email.


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 01 283 1034 for a copy.

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

  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 Blackrock Credit Union Limited 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.