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HEALTH & SKILLED WORKERS COOPERATIVE

3625 Rupert St., Vancouver, BC V5M 3W1


Phone: 604-620 7168 / wecarepadala@gmail.com
Website: www.healthandskilledworkerscooperative.ca

LOAN APPLICATION FORM

Please submit completed application & documents to the Health & Skilled Workers Cooperative Officer.

The H&SWC has adopted a _________to provide immediate financial support to help members in crisis.

Date of Request: ________________________ Amount: $___________ Contact No: _____________


Borrowers Name: ________________________________________ Email: _________________________
Complete Address: ___________________________________________________________________________
(Apt./Suite No.) (Street) (City) (Province) (Postal Code)

Documents attached verifying financial need including postdated cheques, certificate of membership share (both
borrower and co-maker). __________________________________________________________________________

If awarded with the loan, I agree to pay it back within ________ months in equal installments.

PAYMENT SCHEDULE
DATE CHEQUE NO. AMOUNT O.R. NO.

____________________ ______________________________ ________________________________


Borrowers Signature Signature of 1st Co-Maker Signature of 2nd Co-Maker
Name: ________________________ Name: __________________________
Contact No. ____________________ Contact No. ______________________
Email: ________________________ Email: ___________________________
Address: ______________________ Address: _________________________
______________________________ _________________________________

CREDIT COMMITTEE

_________________________ _______________________ _______________________


Chairperson Member Member

Notice of Action: Approved amount of $ ______ with Interest Rate of 2% per month plus Service Fee of 1% of the
Approved Amount: $_______