Fillable Printable Pesonal Financial Statement
Fillable Printable Pesonal Financial Statement
Pesonal Financial Statement
PERSONAL FINANCIAL STATEMENT
Statement of Financial ConditionAsOf______/______/______
Applicant Name:Business Phone
Co-Applicant Name:Business Phone
Residence Address Residence Phone
City, State,& Zip
JOINTCREDITAPPLICATION
By submitting thisPersonalFinancialStatement,we intend to apply for joint credit.
_______________________________ ______________________________
Applicant Signature Co-Applicant Signature
ASSETS
AMOUNT ($)
LIABILITIES&NET WORTH
AMOUNT ( $)
Cash in Bank
(including money market accounts, CDs)
Notes PayabletoBank
Secured
Cash in Other Financial Institutions (List)
(including money market accounts, CDs)
Unsecured
Notes Payableto Others
(Schedule F)
Secured
Unsecured
Credit Cards &AccountsPayable
MarginAccounts
ReadilyMarketableSecurities
(Schedule A)
Notes Due to Privately Owned Businesses
Non-Readily MarketableSecurities
(Schedule A)
Taxes Payable
Ownership in PrivatelyOwned Businesses
(Schedule B)
Personal Residential Mortgages
(Schedule D)
Notes Receivable from Business InvestmentReal EstateDebt
(Schedule E)
Notes Receivable from OthersLifeInsuranceLoans
(Schedule C)
Net Cash Surrender ValueofLife Insurance
(Schedule C)
Other Liabilities (List):
Real Estatefor Personal Use
(Schedule D)
Real EstateInvestments
(Schedule E)
Retirement Accounts
(IRA, Keogh, Profit Sharing & Other)
Automobiles
TotalLiabilities
Other Assets (List):
Net Worth
(Total Assetsminus Total Liabilities)
TotalAssets
TotalLiabilities & Net Worth
SOURCES OFINCOME
CONTINGENTLIABILITIES
Salary As Guarantor, Endorser, or Co-maker
Bonusand CommissionsOn Leasesor Contracts
Interest & Dividends Legal Claims
Real Estate IncomeProvisions for Federal Income Taxes
You need not disclosealimony, child support or separate maintenance inc
ome unless you wish the
Bank to consider them in a credit decision.
Other Special Debt
Other Income (please itemize)
Total IncomeTotal Contingent Liabilities
GENERAL INFORMATIONPERSONAL INFORMATION
Areany assets pledged?
If yes, please list in schedule below.
Businessor Employer – Applicant:
Areyou a defendantinany suits or legal actions? Co-applicant:
US Citizen? If no, Resident Alien Number:Date of Birth – Applicant:
Personal bankaccounts carriedat (name of financial institution): Co-applicant:
Partneror officer inany other venture?:
Haveyou or any business you have ownedever declared bankruptcy? Doyou have awill?
Ifyes, pleaseexplain onadditional sheet. If so, name ofexecutor:
SCHEDULE OF ASSETS PLEDGED
DescriptionValue To Whom Pledged
SCHEDULE A-ALLSECURITIES INCLUDING NON-MONEY MARKET MUTUALFUNDS
(use additional sheet if necessary)
NO. OF
SHARES OR
BOND FACE
VALUE
DESCRIPTION
OWNER(S)
WHERE HELD
CURRENT MARKET
VALUE
PLEDGED
YESNO
READILY MARKETABLESECURITIES (including Stocks, Bonds, Mutual Funds, U.S. Governments, and Municipals)
NON-READILYMARKETABLE SECURITIES (thinly traded orrestricted stock)
SCHEDULEB – OWNERSHIP IN PRIVATELYHELD BUSINESSES
(use additional sheet if necessary)
BUSINESS NAME
NATURE OF
BUSINESS
DATE OF
INVESTMENT
ORIGINAL
INVESTMENT
COST
% OF
OWNERSHIP
PRESENT VALUE
OF YOUR
INVESTMENT
SCHEDULE C – LIFE INSURANCE
(use additional sheet if necessary)
INSURANCE COMPANY
FACE
AMOUNT
OF POLICY
TYPE OF
POLICY
BENEFICIARY
CASH
SURRENDER
VALUE
POLICY
LOANS
OWNERSHIP
PLEDGED
YESNO
SCHECULE D – REALESTATE FORPERSONAL USE
(use additional sheet if necessary)
PROPERTY ADDRESS
LEGAL
OWNER
PURCHASE
YEAR PRICE
MARKET
VALUE
PRESENT
LOAN
BALANCE
INTEREST
RATE
MATURITY
DATE
MONTHLY
PAYMENT
LENDER
SCHEDULEE -REALESTATE INVESTMENTS (MAJORITY OWNERSHIP ONLY)
(use additional sheet if necessary)
PROPERTY ADDRESS
LEGAL
OWNER
PURCHASE
YEAR PRICE
MARKET
VALUE
PRESENT
LOAN
BALANCE
INTEREST
RATE
MATURITY
DATE
MONTHLY
PAYMENT
LENDER
SCHEDULE F- NOTES PAYABLE
TYPE
ORIGINAL
AMOUNT
PRESENT
LOAN
BALANCE
SECURED
COLLATERAL
INTEREST
RATE
MATURITY
DATE
MONTHLY
PAYMENT
LENDER
YESNO
REPRESENTATIONSAND WARRANTIES
The information contained in thisstatement isprovided toinduce Banktoextend or tocontinue the extension of credit totheundersigned or to othersupon the guaranteeof
the undersigned. The undersigned acknowledge and understand that theBankisrelying onthe information provided herein in deciding to grant or to continue to grant credit
or to accept a guarantee thereof. Each of the undersignedrepresents, warrants, and certifiesthat the information provided herein istrue, correct, and complete. Each of the
undersigned agreesto notify the Bank immediatelyand in writing of anychange in name, address or employment and of any material adverse change(1)in anyof the
information contained in this statement or (2) in the financial condition of any of the undersigned or (3) in the abilityof any of the undersigned to perform theirobligations to the
Bank. In the absence of such notice or anew and full written statement, this should be considered asacontinuing statement and substantiallycorrect. If the undersigned fail
to notifythe Bank as required above,or if any of the information herein should prove to be inaccurate or incomplete in anymaterialrespect, the Bankmaydeclare the
indebtednessof the undersigned or the indebtednessguaranteed bythe undersigned, as the case maybe, immediatelydue and payable. Bankis authorized to make all
inquiriesit deemsnecessarytoverify theaccuracy of the information contained herein and to determine the creditworthinessof the undersigned. Eachofthe undersigned
authorizesBankto answer questionsaboutthe Bank'scredit experience with the undersigned. As long asany obligation orguarantee ofthe undersigned toBankis
outstanding, the undersigned shall supply annually an updated personal financial statement. This personal financial statement and any other financial or other information that
the undersigned gives Bank shall become the property of the Bank.
The undersigned authorize any person or consumer reporting agency to give Bank a copy of the undersigned's credit report and any other financial information it may have on the
undersigned, and to prepare at Bank Bank's request, a consumer investigativereport.
Signature: Date:Social Security Number:
Signature: Date: Social Security Number:
(Rev. 9/06)
MKT-62-IN-1
