Loan Application Form - RHAND Credit Union

The Cummings-Fraser Foundation's Application for Assistance

Applicant Details:

Full Name: *

Address: *

Contact Number: *

Email Address: *

Membership Information (RHAND Credit Union/Other Cooperative Society):

Member Status (Check one):

RHAND Credit Union Other Cooperative Society Cooperative Society

Cooperative Society (Specify):

Are you currently an active member in good standing with your Cooperative Society? *

Yes No

If No, provide details:

Disaster/Health Issue Details:

Type of Disaster/Issue (Check one): *

Natural Disaster Personal Disaster Chronic Health Issue Other

Other (Specify):

Date of Occurrence: *

Description of the event: *

Type of Assistance Required (Check all that apply):

Type of Assistance Required (Check all that apply): *

Essential Goods Services Financial Assistance

Supporting Documents:

Please provide evidence to support your claim (e.g., medical reports, police reports,receipts, etc.).

Essential Goods (Specify):

Services (Specify):

Financial Assistance (Specify purpose):

Document 1: *

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Document 2: *

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Document 3: *

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Declaration: I hereby declare that the information provided is true and accurate to the best of my knowledge.

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Last Name *

Date of Birth *

Email Address *

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Address: *

ID Number: *

Email Address: *

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The Cummings-Fraser Foundation's Application for Assistance

Applicant Details:

Disaster/Health Issue Details:

Type of Assistance Required (Check all that apply):

Supporting Documents:

Forgot your account number?

Recover your member number