Existing Customer Application

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Returning Customer

Have you ever had a loan with Cockle Finance Before*

Yes

No

Postcode Checker

Please input postcode district*

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*

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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?*

How many dependants do you have?*

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

Relationship to you

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

Additional Household Income From Other Adults At Your Address*

This is any other money that comes into the home from any other adults that live at your address. We will not need to see evidence of this

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 Rent or Mortgage (Please Select)*

We need to know how much you pay towards your rent/mortgage. 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 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? This Could Be Fixed Or Pay As You Go. (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 Shopping. This Includes Food, Cleaning Products, Clothes etc. (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?*

This includes Car, Petrol, Public Transport 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 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)

Other*

Please Specify

Amount

Page 4 Test

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?*

Responsible Lending

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, redundancy, or getting less money, divorce or separation, a child or someone else you take care of joining 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).

TransUnion - For all consumer enquiries, please visit www.transunion.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?*

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

Significantly improve your chances of being accepted for a loan by seeing your credit report and checking for errors. I want to see a copy of my credit report for free

How did you hear about us?*

Name of the person who recommended you