Temporary Loan Arrangement Request Form Personal DetailsNameMember Number Date of Birth (dd/mm/yyyy) Contact number Email Employment DetailsEmployment Status ---Public SectorEmployedSelf EmployedOther (please state) Other - Details Current Employer Worried about loan repayments due to one of the followingTemporary lay off due to covid 19Reduced Income due to covid 19Other (please state) Mandatory acknowledgements required I acknowledge that Carlow District Credit Union may require supporting documentation to fully consider my request. YesNo I understand and acknowledge that the arrangement, if approved, will be temporary and will start and finish on the specified dates agreed in writing with Carlow District Credit Union. YesNo I understand and acknowledge that my original Credit Agreement will be amended temporarily for the time period that will be specified in writing and my original Credit Agreement will be re-instated on the date this temporary arrangement ends. YesNo I understand that it is my responsibility to amend the payments to my loan account for the duration of the arrangement period. Any extra funds transferred during the arrangement period will not be reimbursed to me. YesNo I agree to the terms and conditions for access to and use of the Carlow Credit Union website and web forms and to the processing of my data, which may include sensitive data, for the purposes of reviewing this application in accordance with the Privacy Notice. YesNo