New Customer Application

Step 1 of 6

16%

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*

What's your residential status*
Please specify
Have you lived at your address for more than 3 years?*
Previous Address (If less than 3 years at current address)*
Street Address Address Line 2 City County / State / Region ZIP / Postal Code
What is your marital status?*
Do you have any children under 18 that live with you?*
How many children under 18 do you have?*
Do you have any pets?*

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 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*

Do you have any other loans with anyone other than Cockle Finance?*
*
Name of Company You Have The Loan With Amount You Pay Back How Often Do You Pay This?
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?*
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
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!

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

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

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