NOTE: Information completed on this form must match details DWP hold and the evidence supplied with the form, or previously provided to DWP.  The referral will be returned to the Lender if any information is incorrect. 

The Eligible Loan Deductions Scheme Referral Form

To: Cru.elds@dwp.gov.uk   To submit your referral by post please use address at the bottom of this form.	Date: 	
From: 	Lender ID: 	

 Section 1: Customer Details 
NINO: 	DoB: 	 Gender: Male            Female	

Title: 	First Name: 	Surname: 	
Address:

Home Telephone Number (if known): 
	Mobile Telephone Number (if known):
	
Joint Loan Details (please note this is for information only. A separate referral must be submitted if you wish us to consider deductions). 

NINO:                                                                      Name: 	

 Section 2: Instruction to Recover  

 Loan Details
Current Loan Amount:	Amount of Loan outstanding to recover:
	
Previous recovery from DWP
Yes or No 	If Yes how much was recovered:
	
Loan Reference Number:	Loan Approved Date:

Last Payment Date:	

I declare that the above information is true and complete and that the loan meets the    criteria listed in the Memorandum of Understanding (MoU).  We have carried out the steps outlined in Schedule 1 para 10 of the MoU and confirm that there have been no changes to our circumstances since the current loan application form was signed.  A copy of the   current loan agreement form is attached.

Signed:

Name: 

On behalf of:                                                                               Date:	

 Please return this form to:
 Lender Management Team

 Eligible Loan Deductions Scheme
 Post Handling Site B
 Wolverhampton
 WV99 2FQ