Membership application form

Derbyshire Community Bank is the trading name for Erewash Credit Union. To be eligible to join the Credit Union, you need to be aged 18 or over; living or working in Derbyshire; or living with and a relative of someone living or working in Derbyshire.

To join a deposit of £1 is required and must be maintained as your minimum shareholding in the bank. This is a condition of membership.

Please note that this process is not a 'real time' transaction and that there will be a short delay between your submission and the application being processed within the credit union office.

  • ALL fields marked with an " *" are mandatory and you must enter/select the appropriate information.
PERSONAL details:
Title: *
Forename: *
Middle name(s):
Surname: *
Household status: *
Home address House number / name or: *
  Flat number:
  Street *
  Town *
  Postcode: *
When did you start living here: / /
Gender: *
Date of birth: / / * (Age: )
National insurance number: *
Ethnicity: *
E-mail: *
Home telephone: *
Mobile telephone:
Do you pay tax outside of the United Kingdom ? *
ID verification methods:
Please provide a mimimum of one of the following items in order to verify your identity.
Driving licence number
Passport number
Work details:
If you don't live in Derbyshire we will need your employment details to confirm that you are eligible to join as a result of working in Derbyshire.
Employment status: *
Beneficiary details:
It is important to provide these details as your beneficiary will be awarded your savings in the event of your death.
Beneficiary name:
Relationship to you:
Beneficiarys address: House/Flat No and street name:
Beneficiarys contact number:
Banking details
Please use the details below to pay money into my bank account in the form of loans and share withdrawals when requested. I accept that Erewash Credit Union will not be liable if the details are entered incorrectly.
Sort code:
Account number:
Building society roll number: (if applicable)
Name on account:
Additional information
I * wish to receive annual statements from the credit union via email. Statements not sent via email will be sent via post.
I * wish to receive promotional information from the credit union via email.
How did you hear about us ? *
A guide to what we do and how both we and credit reference and fraud prevention agencies will use your information can be found on our website at:


In accordance with the principles of the Data Protection Act 1998 we will use your personal details for the purposes of establishing your identity and managing your account with the Credit Union. Your personal details will be treated confidentially and will only be shared with other agencies for the purpose of credit referencing and debt recovery for which the credit union hold the appropriate Consumer Credit Licence.


I * to abide by the rules of the Credit Union and declare that the information given by me on this form is true and correct to the best of my knowledge and belief.

By submitting this form, you are agreeing to an online ID check. This is not a credit check.


Click here to download a copy of the FSCS Information Sheet.
Further copies can be requested at any time by contacting

I have read the above FSCS Information Sheet and downloaded a copy for future reference. * ( please tick to confirm )
Human verification