New Customer Application

Step 1 of 6

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

Does anyone at the address you live at contribute to the money coming in or the bills being paid?*
Persons Name
Relationship to you
Are you in employment?*
Are you Self Employed?*
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?*
Do you claim any benefits?*
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 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*
Frequency*
Self Employed Income
Amount*
Frequency*
Employment Support Allowance (ESA)
Amount*
Frequency*
Job Seekers Allowance (JSA)
Amount*
Frequency*
Disability Living Allowance (DLA)
Amount*
Frequency*
Universal Credit
Amount*
Frequency*
Child Tax Credits
Amount*
Frequency*
Child Benefit
Amount*
Frequency*
Income Support
Amount*
Frequency*
Pension
Amount*
Frequency*
Personal Independent Payments (PIP)
Amount*
Frequency*
Carers Allowance
Amount*
Frequency*
Working Tax Credits
Amount*
Frequency*
Other
Please Specify
Amount*
Frequency*
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? (Please Select)*
We need to know if anyone at the address you live at pays towards the outgoings with you.
Relationship to you*
What's The Name Of The Person Who Pays This?*
Do You Pay A Mortgage (Please Select)*
Please Select
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 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)*
Frequency*
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)*
Frequency*
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)*
Frequency*
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)*
Frequency*
Do You Pay Your Phone Bill? (Please Select)*
If this includes anything like Sky, Broadband etc please include everything.
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 Other Utilities Like Sky, Virgin, Broadband etc? (Please Select)*
If this was included in your phone bill 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)*
Frequency*
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)*
Frequency*
Do You Spend Money On Takeaways*
Please put an average for the week/month
Amount that You Pay Towards This (If you split this with someone else please just put the part you pay)*
Frequency*
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)*
Frequency*
Do You Have A Car?*
How Much 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)*
Frequency*
How Much 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)*
Frequency*
Do You Have To Pay Any Costs For Your Children?*
This 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)*
Frequency*
How Much Do You Have To Pay Towards Pet Costs?*
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)*
Frequency*
How Much Do You Pay For Hobbies, Entertainment and Days Out?*
Amount that You Pay Towards This (If you split this with someone else please just put the part you pay)*
Frequency*
How Much Do You Spend On Alcohol & Tobacco?*
Amount that You Pay Towards This (If you split this with someone else please just put the part you pay)*
Frequency*
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)*
Frequency*

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
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.
Amount You Wanted To Borrow?*
Cockle Finance has teamed up with UK Credit Ratings, you can check your credit report & credit score for free. To check your credit report for free, click the image below:
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).*
- 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?*
Who told you about us?

We offer a recommend a friend scheme so if you're accepted, the person who recommended you could get a £10 Love2Shop voucher!

Name of Company You Have The Loan With	Amount You Pay Back	How Often Do You Pay This?

Name	Relationship to you

Step 1 of 6

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

Outgoings

Responsible Lending

Important Information