Existing Customer Application

Title*
First Name*
Surname*
Address*
Street Address Address Line 2 City County / State / Region ZIP / Postal Code
Gender*
D.O.B*
Contact Number*
Email

What's your residential status*
Please specify
How long have you lived at your current address?*
What is your marital status?*
Do you have any children?*
How many children do you have?

Does anyone at the address you live at contribute to the money coming in or the bills being paid?*
Persons Name
Relationship to you
What is your employment status?*
Please spefify
What company do you work for?
What is the address of your employer?
Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country
How long have you worked there?
If you are employed, we will need to see evidence of this. For example, bank statements.
If you are self employed, we will need to see evidence of this. For example, bank statements.
Is your benefit a joint claim?
Name of person you claim with
Relationship to you

Incomings
Please list all your incomings
Salary
Amount
Frequency
Benefit 1
Benefit Type
Amount
Frequency
Benefit 2
Benefit Type
Amount
Frequency
Benefit 3
Benefit Type
Amount
Frequency
Benefit 4
Benefit Type
Amount
Frequency
Child Tax
Amount
Frequency
Child Benefit
Amount
Frequency
Partner Salary
Amount
Frequency
Outgoings
Please list all your outgoings
Mortgage
Amount
Frequency
Rent
Amount
Frequency
Council Tax
Amount
Frequency
Gas
Amount
Frequency
Electric
Amount
Frequency
Water
Amount
Frequency
Phone Bill
Amount
Frequency
Food
Amount
Frequency
Other Utilities (i.e. Sky)
Amount
Frequency
Other
Amount
Frequency

Do you have any other loans with anyone other than AJ Cockle Finance?*
Name of creditor Amount you pay back Frequency
Do you have any county court judgments?*
Have you ever been bankrupt?*
Have you ever taken out a IVA?*
Do you know the amount of money you previously borrowed from AJ Cockle Finance?*
How much did you borrow?
How much would you like to borrow from AJ Cockle Finance?*
Does anyone else at your address have a loan with AJ Cockle Finance?*
Name Relationship to you

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 repauments. 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
*
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
*
By tick the box below you give permission for one of our agents to visit you at your home to discuss your application.
- I agree
If accepted for a loan, you can choose to have the funds loaded onto our Cockle Finance Card. If accepted for the loan would you like the funds loaded onto a Cockle Finance Card?*
- Yes I want the funds on a Cockle Finance Card
- No I would like cash
To find out more about the Cockle Finance Card visit www.cocklefinance.co.uk/cockle-finance-card/

Existing Customer Application

Step 1 of 6

Incomings

Outgoings

Responsible Lending

Important Information

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