Fillable Printable Pesonal Financial Statement
Fillable Printable Pesonal Financial Statement
Pesonal Financial Statement
PERSONAL FINANCIAL STATEMENT
Statement of Financial Condition As Of ______/______/______
Applicant Name: Business Phone
Co-Applicant Name: Business Phone
Residence Address Residence Phone
City, State, & Zip
JOINT CREDIT APPLICATION
By submitting this Personal Financial Statement, 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 Payable to Bank
Secured
Cash in Other Financial Institutions (List)
(including money market accounts, CDs)
Unsecured
Notes Payable to Others
(Schedule F)
Secured
Unsecured
Credit Cards & Accounts Payable
Margin Accounts
Readily Marketable Securities
(Schedule A)
Notes Due to Privately Owned Businesses
Non-Readily Marketable Securities
(Schedule A)
Taxes Payable
Ownership in Privately Owned Businesses
(Schedule B)
Personal Residential Mortgages
(Schedule D)
Notes Receivable from Business Investment Real Estate Debt
(Schedule E)
Notes Receivable from Others Life Insurance Loans
(Schedule C)
Net Cash Surrender Value of Life Insurance
(Schedule C)
Other Liabilities (List):
Real Estate for Personal Use
(Schedule D)
Real Estate Investments
(Schedule E)
Retirement Accounts
(IRA, Keogh, Profit Sharing & Other)
Automobiles
Total Liabilities
Other Assets (List):
Net Worth
(Total Assets minus Total Liabilities)
Total Assets
Total Liabilities & Net Worth
SOURCES OF INCOME
CONTINGENT LIABILITIES
Salary As Guarantor, Endorser, or Co-maker
Bonus and Commissions On Leases or Contracts
Interest & Dividends Legal Claims
Real Estate Income Provisions for Federal Income Taxes
You need not disclose alimony, 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 Income Total Contingent Liabilities
GENERAL INFORMATION PERSONAL INFORMATION
Are any assets pledged?
If yes, please list in schedule below.
Business or Employer – Applicant:
Are you a defendant in any suits or legal actions? Co-applicant:
US Citizen? If no, Resident Alien Number: Date of Birth – Applicant:
Personal bank accounts carried at (name of financial institution): Co-applicant:
Partner or officer in any other venture?:
Have you or any business you have owned ever declared bankruptcy? Do you have a will?
If yes, please explain on additional sheet. If so, name of executor:
SCHEDULE OF ASSETS PLEDGED
Description Value To Whom Pledged
SCHEDULE A - ALL SECURITIES INCLUDING NON-MONEY MARKET MUTUAL FUNDS
(use additional sheet if necessary)
NO. OF
SHARES OR
BOND FACE
VALUE
DESCRIPTION
OWNER(S)
WHERE HELD
CURRENT MARKET
VALUE
PLEDGED
YES NO
READILY MARKETABLE SECURITIES (including Stocks, Bonds, Mutual Funds, U.S. Governments, and Municipals)
NON-READILY MARKETABLE SECURITIES (thinly traded or restricted stock)
SCHEDULE B – OWNERSHIP IN PRIVATELY HELD 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
YES NO
SCHECULE D – REAL ESTATE FOR PERSONAL 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
SCHEDULE E - REAL ESTATE 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
YES NO
REPRESENTATIONS AND WARRANTIES
The information contained in this statement is provided to induce Bank to extend or to continue the extension of credit to the undersigned or to others upon the guarantee of
the undersigned. The undersigned acknowledge and understand that the Bank is relying on the information provided herein in deciding to grant or to continue to grant credit
or to accept a guarantee thereof. Each of the undersigned represents, warrants, and certifies that the information provided herein is true, correct, and complete. Each of the
undersigned agrees to notify the Bank immediately and in writing of any change in name, address or employment and of any material adverse change (1) in any of the
information contained in this statement or (2) in the financial condition of any of the undersigned or (3) in the ability of any of the undersigned to perform their obligations to the
Bank. In the absence of such notice or a new and full written statement, this should be considered as a continuing statement and substantially correct. If the undersigned fail
to notify the Bank as required above, or if any of the information herein should prove to be inaccurate or incomplete in any material respect, the Bank may declare the
indebtedness of the undersigned or the indebtedness guaranteed by the undersigned, as the case may be, immediately due and payable. Bank is authorized to make all
inquiries it deems necessary to verify the accuracy of the information contained herein and to determine the creditworthiness of the undersigned. Each of the undersigned
authorizes Bank to answer questions about the Bank's credit experience with the undersigned. As long as any obligation or guarantee of the undersigned to Bank is
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 investigative report.
Signature: Date: Social Security Number:
Signature: Date: Social Security Number:
(Rev. 9/06)
MKT-62-IN-1
