Cockle Finance Application

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Returning Customer

Have you ever had a loan with Cockle Finance Before*

Yes

Postcode Checker

Please input postcode discrict*

Only enter first half e.g. CM12

Your Details

Name and Title

First Name

Last Name

Address

Street Address

Address Line 2

City

Zip/Postcode

State/Province/Region

D.O.B ×

Email Address

Contact Number

Page 1

What's your residential status*

Please specify*

Write Here

Have you lived at your address for more than 6 years?*

Previous Address (If less than 3 years at current address)

Street Address

Address Line 2

City

Zip/Postcode

State/Province/Region

What is your marital status?*

Do you have any children under 18 that live with you?*

How many children under 18 do you have?*

Write Here

Do you have any pets?*

Page 2

Does anyone at the address you live at contribute to the money coming in or the bills being paid?*

Persons Name*

Persons Name

Write Here

Are you in employment?*

Are you self employed? *

What is the name of your employer?*

Employers Name

How long have you worked there?*

How long have you worked there?

What is the address of your employer?

Street Address

Address Line 2

City

Zip/Postcode

State/Province/Region

Country

Do you claim any benefits?*

Is your benefit a joint claim?*

Joint Claimant *

Name of person you claim with

Relationship to you

Page 3

Incomings - Please note anything you put here we will need to see proof of for it to be considered in your application.

Please list all your incomings. If you receive a joint benefit claim please split the amount by 50% (for example if you and your partner get £100 ESA between you then please just put £50 for you).

Salary (If you're employed)*

Amount

Self Employed Income*

Amount

Employment Support Allowance (ESA)*

Amount

Job Seekers Allowance (JSA)*

Amount

Disability Living Allowance (DLA)*

Amount

Universal Credit*

Amount

Child Tax Credits*

Amount

Child Benefit*

Amount

Income Support*

Amount

Pension*

Amount

Personal Independent Payments (PIP)*

Amount

Carer's Allowance*

Amount

Working Tax Credits*

Amount

Other*

Please Specify

Amount

Outgoings

Please list all your outgoings - If you split any of these with a partner, we just need to know the part that YOU pay. If someone else pays this then please leave it blank.

Are any of the bills or outgoings you pay split with someone else?*

We need to know if anyone at the address you live at pays towards the outgoings with you.

What's The Name Of The Person Who Pays This?

Do You Pay A Mortgage (Please Select)*

Amount that you pay towards this (If you split this with someone else please just put the part you pay)

Do You Pay Towards Your Rent (Please Select)*

We need to know how much you pay towards your rent. If Money is paid directly from your benefits we just need to know what extra you pay towards this.

Amount that you pay towards this (If you split this with someone else please just put the part you pay)

Frequency*

Do You Pay Towards Your Council Tax? (Please Select)*

We need to know how much you pay towards your Council Tax? If Money is paid directly from your benefits we just need to know what extra you pay towards this.

Amount that you pay towards this (If you split this with someone else please just put the part you pay)

Do You Pay For Electricity? (Please Select)*

Amount that you pay towards this (If you split this with someone else please just put the part you pay)

Do You Pay For Gas? (Please Select)*

Amount that you pay towards this (If you split this with someone else please just put the part you pay)

Do You Pay Towards Your Water Bill? (Please Select)*

If this is included in your rent please select ‘This Doesn’t Have To Be Paid At all

Amount that you pay towards this (If you split this with someone else please just put the part you pay)

Do You Pay Your Phone Bill? (Please Select)*

Amount that you pay towards this (If you split this with someone else please just put the part you pay)

Do You Pay Towards Other Utilities Like Sky, Virgin, Broadband etc? (Please Select)*

Amount that you pay towards this (If you split this with someone else please just put the part you pay)

We Need To Know About Your Food Shopping? (Please Select)*

This includes a food shop at a supermarket, lunches during the week, dinners etc. If you have a family this is the whole amount for them.

Amount that you pay towards this (If you split this with someone else please just put the part you pay)

Do you spend money on travel? (Public Transport etc)*

Amount that you pay towards this (If you split this with someone else please just put the part you pay)

Do You Have A Car?*

Do You Spend On Petrol?*

Amount that you pay towards this (If you split this with someone else please just put the part you pay)

Do You Spend On Car Insurance?*

Amount that you pay towards this (If you split this with someone else please just put the part you pay)

Do you spend on takeaways?*

This should be an average for the week/month

Amount

How much do you spend on costs for your children?*

his could be childcare costs, after school clubs pocket money etc.

Amount that you pay towards this (If you split this with someone else please just put the part you pay)

How much do you spend on costs for your pets?*

This will be things like pet food, pet toys, Insurance etc.

Amount that you pay towards this (If you split this with someone else please just put the part you pay)

How Much Do You Pay For Hobbies, Entertainment and Days Out?*

Amount

How Much Do You Spend On Alcohol & Tobacco?*

Amount*

Amount

How Much Do You Spend On Repayments On Other Loans, Credit Cards etc (This is NOT payments to Cockle Finance)*

Amount that you pay towards this (If you split this with someone else please just put the part you pay)

Page 4

Do you have any other loans with anyone other than Cockle Finance?*

Please list all loans below

Do you have any county court judgments?*

Have you ever been bankrupt?*

Have you ever taken out a IVA or Debt Relief Order?*

Have you ever taken out a Debt Management Plan?*

Does anyone else at your address have a loan with Cockle Finance*

Please list all people

Responsible Lending

We want to make sure that you can afford repayments on this loan. To decide if you can afford this, we will use information on your finances as they are right now.

Is something in your life about to change?

Future changes in your life may make it harder for you to make repayments. For example: working fewer hours, retirement, redundance, or getting less money, divorce or separation, a child or someone else you take care of joinging your household.

If you have any changes you're expecting then please phone us on 01708 755490 and let us know.

I'm not aware of any changes to my circumstances which may have an impact of my ability to manage this loan. *

By submitting this form you confirm that you can afford to make the repayments on the loan.

If you do not understand anything on this form please call one of our team on 01708 755490

By ticking this box you give permission for one of the team at Cockle Finance to visit you at your home address to discuss a loan with you. *

Important Information

Cockle Finance is authorised and regulated by the Financial Conduct Authority, 25 North Colonnade, Canary Wharf Group, London, E14 5HS.

It is also a member of the Consumer Credit Association, Queens House, Queens Road, Chester, CH1 3BQ.

Data - How to find out more

Cockle Finance will use the information provided to determine whether or not to issue you with a loan. To do this we may use Callcredit or Experian to perform a credit search.

Cockle Finance will not share your data with anyone else.

For full details on how your data may be used please contact the Consumer Credit Association or the agencies below (they may charge a small statutory fee).

Callcredit - Consumer Services Team, PO Box 491, Leeds, LS3 1WZ or call 0870 060 1414 or visit www.callcreditcheck.co.uk

Experian - Consumer Help Services, PO Box 8000, Nottingham NG80 7WF or call 0844 481 8000 or visit www.experian.co.uk

What's the reason for you taking out the loan? Please be specific and tell us EXACTLY why you need to take the loan out.*

Please note that if you are struggling financially and are borrowing money for that reason, your loan application will not be accepted.

Write Here

Amount You Wanted To Borrow?*

Please note new Customers can borrow up to £300 on their first loan

We take your privacy very seriously! We make sure that the data you provide to us is secure and not misused. You can view our privacy notice here: https://www.cocklefinance.co.uk/privacy-policy/ By Ticking this box you agree to the use of your data as stated in our Privacy Policy.*

I agree

We may perform a credit check on you to aid us in our credit granting decision. By ticking this box and submitting this application, you agree to us performing a credit check and registering this application (see our privacy notice).*We may perform a credit check on you to aid us in our credit granting decision. By ticking this box and submitting this application, you agree to us performing a credit check and registering this application (see our privacy notice).*

I agree

By ticking this box, you accept that all the details you have submitted in this application are true and correct. You accept that the loan decision that we make will be aided by the details within this application. You also accept that you have no foreseeable change of circumstances that will affect your ability to make repayments on any loan you are accepted for.*

I agree

How did you hear about us?*

Name of the person who recommended you

Marina Relf

15:34 13 Mar 19

Very helpful and great weekly payment very friendly staff

Brian Askew

01:30 15 Feb 19

Very friendly and helpful staff. Reasonable rates too......all in all a five star company

Lily French

19:29 13 Dec 18

Been with these for years now. Lovely people great company. Highly recommend definitely there when I needed help. Thanks guys

daisy masters

08:23 26 Oct 18

Been with this company for few years now always happy to help me with any problems... they make you feel like part of Thier family .... thanks

erica macdonald

03:36 09 Oct 18

Amazing service and friendly people would reccommend if need a quick loan

Jij Shh

20:56 25 Sep 18

Excellent customer service Steve thank so much mate

Andrew Bourne

13:15 18 Jun 18

Great family run company very friendly also fantastic customer service

Tracey Goodrum

20:47 13 Apr 18

Such a lovely family run business and always there to help you I really would recommend and I have been a customer for a few years now they never let you down Steve and jan are such lovely people ?

Ricky Hollands

16:09 06 Feb 18

Steve & His team have been apart of my family for over 20 years , they are fantastic , they take each case at its own face value, they understand peoples circumstances really friendly & approachable , keep up the good work.. i will be a client for many years to come , Ricky & Sarah

Char Turner

17:01 13 Jan 18

Amazing service.. Wish I could more stars.. They have amazing customer service.. And Steve is very friendly x

seany Brannigan

16:00 13 Dec 17

fantastic company have been a customer for some time rapid response for telephone enquiries totally professional manor regarding repayments that are reasonable but most of all take time to listen that's why I give this company 5* recommended

Steven Thomas

08:33 11 Dec 17

This is a family run business very friendly so if you struggle to get credit anywhere dont matter A j cockels got me out off trouble loads of times i would so recommend ??.

Shirley Webber

12:22 29 Nov 17

Great company staff are so helpful and polite Steve and Dan *****

Sandie Filipe

20:44 28 Nov 17

Great family run company been using for over 18 years and never had a problem always friendly and happy to help and great rates would highly recommend beats all other similar company's hands down

Sharon Milner

15:27 16 Nov 17

Great company and service!

Gary Beckett

09:38 15 Nov 17

Needed a small loan in a hurry and found this company when I was looking online. I cannot fault the whole process went on their website looked at there rates using the slider, which were very competitive.Filled out the form and was contacted by a member of staff shortly afterwards, They arranged to come and drop the loan off and the guy who came Dan was great to deal with.I will certainly be using AJ Cockle again!

Mark Browning

11:00 22 Jun 17

its a family run business rates very reasonable highly recommended

Cockle Finance Application

Returning Customer

Postcode Checker

Your Details

Page 1

Page 2

Page 3

Incomings - Please note anything you put here we will need to see proof of for it to be considered in your application.

Outgoings

Page 4

Please list all loans below

Please list all people

Responsible Lending

Responsible Lending

Is something in your life about to change?

Important Information

Data - How to find out more

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