Fillable Printable Personal Financial Statement - US Bank
Fillable Printable Personal Financial Statement - US Bank
Personal Financial Statement - US Bank
PFS for CONFIDENTIAL Page 1 of 3
PERSONAL FINANCIAL STATEMENT
Bank:
You may apply for an extension of credit individually or jointly with another applicant. This statement and any applicable supporting schedules may be
completed jointly by co-applicants if their assets and liabilities can be meaningfully and fairly presented on a combined basis, otherwise separate
statements and schedules must be provided. If you are applying for an unsecured individual loan, you do not need to complete any information
concerning a co-applicant unless another person will be permitted to use the account or you wish the co-applicant’s or other person’s income to be relied
upon as the basis for repayment. For the purpose of obtaining credit from time to time with the bank, the following statement and information are
furnished as a complete, true, and accurate statement of the financial condition of the undersigned on . All amounts are rounded to the nearest
$100.
APPLICANT CO-APPLICANT
Full Name
Full Name
Street Address
Street Address
City/State/Zip
City/State/Zip
County
County
Since
Own Rent
$
Since
Own Rent
$
Previous Address (if less than 5 years at present)
Previous Address (if less than 5 years at present)
City/State/Zip
City/State/Zip
Since
Owned Rented Since
Owned Rented
Social Security #
Date of Birth
Social Security #
Date of Birth
Phone: Residence
Work
Phone: Residence
Work
Employer
Employer
Address
Address
Position/Title
Since
Position/Title
Since
Previous Employer
Previous Employer
Position/Title
How Long
Position/Title
How Long
Dependents (include self)
Dependents (include self)
Marital Status *
Unmarried Married Separated
Marital Status *
Unmarried Married Separated
* Do not provide this information if your application is for individual, unsecured credit.
ASSETS LIABILITIES
Cash (Schedule 1)
Short Term Notes Due Financial Insts. (Schedule 7)
Securities (Schedule 2)
Short Term Notes Due to Others (Schedule 7)
Life Insurance Cash Value (Schedule 3)
Credit Accounts and Bills Due (Schedule 8)
Mortgages and Contracts Held by You (Schedule 4)
Insurance Loans (Schedule 3)
Homestead (Schedule 5)
Installment Loans and Contracts (Schedule 7)
Other Real Estate (Schedule 5)
Mortgages on Home (Schedule 5)
Profit Sharing & Pension (Schedule 6)
Mortgages on Other Real Estate (Schedule 5)
Retirement Accounts, include IRA Accts. (Schedule 1)
Taxes
Automobile (Describe)
Other Liabilities (Describe)
Personal Property
Other Assets (Describe)
Total $
0
Total $
0
(Total Assets Less Total Liabilities) Net Worth $
0
PFS for CONFIDENTIAL Page 2 of 3
Please contact your banker if you need assistance with completing these schedules. Round all amounts to the nearest $100.
* ANNUAL INCOME APPLICANT CO-APPLICANT PLEASE ANSWER EACH QUESTION (Yes / No) APP. CO-APP
Salary
Bonuses/Commissions
Are you a Co-Maker, Endorser or Guarantor of
any other person’s debt?
Dividends/Interest
Net Real Estate Income
Are you a defendant in any suit or legal action?
* Income from alimony, child support, or
maintenance payments need not be entered
unless you want it considered as a base for
repayment.
Have you ever gone through bankruptcy or had a
judgment against you?
Other (List)
Total 0 0
Have you made a will?
SCHEDULE 1 / CASH, SAVINGS, CERTIFICATES AND IRA ACCOUNTS
Name of Bank or Financial Institution Type of Account Acct. Balance
Total $ 0
SCHEDULE 2 / SECURITIES OWNED
Par Value or
No. of Shares Description
Registered in
Name(s) of
Listed or
Unlisted
Current Market
Value
Total $ 0
SCHEDULE 3 / LIFE INSURANCE
Insurance Company Insured Beneficiary
Face Value
of Policy
Cash Value
of Policy Loans
Total $ 0 0
PFS for CONFIDENTIAL Page 3 of 3
SCHEDULE 4 / RECEIVABLES DUE TO ME ON MORTGAGES AND CONTRACTS I OWN
Name of Debtor Description of Property
First Lien or
Second Lien
Date of
Maturity Repayment Terms Balance Due
per
per
per
Total $ 0
SCHEDULE 5 / REAL ESTATE OWNED
Property Description Name of Creditor
Year
Acquired
Purchase
Price
Mortgage
Balance
Date of
Maturity Repayment Terms
Current Market
Value
per
per
per
per
per
per
Insurance Co.: Agent:
Total $ 0
SCHEDULE 6 / PROFIT SHARING AND PENSION
Name of Institution Type of Account
Account
Balance
Amount Totally
Vested Loans
Total $000
SCHEDULE 7 / INSTALLMENTS, CREDIT LINES AND NOTES
Name of Creditor Collateral
Date of
Maturity Repayment Terms Balance Due
per
per
per
per
Total $ 0
SCHEDULE 8 / CREDIT ACCOUNTS, BILLS DUE, ALIMONY/CHILD SUPPORT, DAYCARE, ETC.
Name of Company Repayment Terms Balance Due
per
per
per
per
per
Total $ 0
You certify that the information provided in this statement is true and correct. So long as you owe any sums to the bank, you agree to give the bank
prompt written notice of any material change in your financial condition and, upon request, you agree to provide the bank with an updated personal
financial statement. The bank is authorized to retain this personal financial statement whether or not credit is approved and is further authorized to verify
your credit and employment history or any other information in this statement. This application does not obligate the bank to make any loan even if you
meet the normal standards the bank considers in determining whether to approve or deny the application.
Applicant’s Signature Date Co-Applicant’s Signature Date
