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PERSONAL FINANCIAL STATEMENT
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Important Information when applying for a loan: To help the government fight the funding of terrorism and money laundering activities, federal law requires all financial institutions to obtain, and record information the identifies each person who opens an account. What this means for you: When you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents.
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Section 1 - Individual Information (type or print)
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Applicant Name:Spouse's Name:
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Date of Birth:Social Security #: Date of Birth:Social Security #
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Home Phone:Email:
Home Phone:
Email:
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Address:Address:
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City, State , Zip:Country:
City, State, Zip:
Country:
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 Own Rent Rent per Month Own Rent Rent per Month
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# of Dependents:Age of Dependents:# of Dependents:0Age of Dependents:
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Marital Status: Married Unmarried SeparatedMarital Status: Married Unmarried Separated
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Employer's Name:Employer's Name:
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Job Position:Job Position:
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Business Phone:Years on Work:Business Phone:Years on Work:
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Section 2 - Annual Income
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Gross Annual IncomeApplicantSpouseTotalDescribe Other Income
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Base Employment Income $ Notice: Alimony, child support or separate maintenance income need not be disclosed if the Applicant or Spouse does not wish to have the income considered as a basis for repaying this loan.
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Overtime $ $
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Commissions $ $
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Dividends/Interest $ $
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Rental Income $ $
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Alimony/Child Support $ $ $
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Other Annual Income $ $ $
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Other Annual Income $ $ $
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Other Annual Income $ $ $
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Total $ $ $
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Section 3 - Financial Condition as of Signed Date
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AssetsAmountLiabilities Amount
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Cash, Checking & Savings, CD's - see Schedule A $ Revolving Credit - See Schedule D $
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Publicly Traded Investments - see Schedule B $ Installment Loans - See Schedule E $
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Other Assets - See Schedule C $ Mortgage Loans - See Schedule of Real Estate $
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Net Worth of Business(es) Owned $ Other Liabilities - See Schedule F $
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Real Estate Owned - See Schedule of Real Estate $ Other : $
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Total Assets $ Total Liabilities $
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Net Worth (Total Assets minus Total Liabilities) $
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PERSONAL FINANCIAL STATEMENT
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Schedule A - Cash, Checking & Savings, CD's
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Name of BankAccount Description/Account OwnerCurrent Balance
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 $
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Total: $
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Schedule B - Publicly Traded Investments: Brokerage Firms, Stocks, Bonds, Mutual Funds, IRAs, 401k
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Name(s) RegisteredAccount DescriptionShares/AmtRetirementCurrent Value
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 Yes No
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 Yes No
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 Yes No
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 Yes No
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Total: $
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Schedule C - Other Assets - Vehicles, Boats, Personal Assets, Cash-value Life Insurance Owned by Signer
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Property DescriptionName(s) Registered InCurrent Value
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 $
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 $
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 $
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 $
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Total: $
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Schedule D - Revolving Credit: Credit Cards, Credit Lines (Do Not Include Home Equity Lines of Credit)
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To Whom PayableDescriptionCommitment AmtMonthly PmtCurrent Balance
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 $ $
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 $ $ $
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 $ $ $
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 $ $ $
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Total: $
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Schedule E - Installment Loans: Cars, Boats, Furniture, Etc.
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To Whom PayableDescriptionCommitment AmtMonthly PmtCurrent Balance
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 $ $ $
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 $ $ $
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 $ $ $
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 $ $ $
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Total: $
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Schedule F - Other Liabilities: Contract Debts, Lawsuits, Tax Penalties
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To Whom PayableDescriptionCommitment AmtMonthly PmtCurrent Balance
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 $ $ $
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 $ $ $
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 $ $ $
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 $ $ $
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Total: $
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