Personal Financial Statement Form

You may apply for a credit extension, loan or other financial accommodation alone or together with someone else (“co-applicant”). This statement and any applicable supporting schedules may be completed jointly by both married and unmarried co-applicants if their assets and liabilities are sufficiently joined so that the statement can be meaningfully and fairly presented on a combined basis and you are applying jointly; otherwise separate statements and schedules are required.

SBA Loan Applicants ONLY: If applying individually, your spouse must still complete the co-applicant section and include all spousal assets on the Personal Financial Statement. As a Federal Special Purpose Credit Program, the SBA requires this information for program eligibility purposes; however, this does not require you to become a borrower on this credit.
I am/we are applying for credit:
- Individually
- Individually with spouse (SBA only)
- Jointly
Applicant/Guarantor
Full Name*
Current Address
Street Address Address Line 2 City State ZIP Code
County
Years at Residence
Own or rent?
- Own
- Rent
Previous Address
Street Address Address Line 2 City State ZIP Code
ID Type
ID Number
ID State of Issuance
State
ID Issued Date
ID Expiration Date
Social Security Number
Date of Birth
Cell Phone
Home Phone
Work Phone
Employer
Employer Address
Street Address Address Line 2 City State ZIP Code
Position/Title
Years of Service
Dependents (including yourself)
Name Age
Marital Status
- Unmarried
- Married
- Separated
Co-Applicant/Co-Signer/Co-Guarantor
Full Name
Current Address
Street Address Address Line 2 City State ZIP Code
County
Years at Residence
Own or rent?
- Own
- Rent
Previous Address
Street Address Address Line 2 City State ZIP Code
ID Type
ID Number
ID State of Issuance
State
ID Issued Date
ID Expiration Date
Social Security Number
Date of Birth
Cell Phone
Home Phone
Work Phone
Employer
Employer Address
Street Address Address Line 2 City State ZIP Code
Position/Title
Years of Service
Dependents (including yourself)
Name Age
Marital Status
- Unmarried
- Married
- Separated
Applicant Annual Income
Please input numbers -- e.g. 3000 -- without dollar signs or shorthand indicators ("3k").
Salary
Bonuses & Commissions
Rental Income
Interest Income
Dividend Income
Other Income
Type Amount
TOTAL APPLICANT INCOME
Co-Applicant Annual Income
Please input numbers -- e.g. 3000 -- without dollar signs or shorthand indicators ("3k").
Salary
Bonuses & Commissions
Rental Income
Interest Income
Dividend Income
Other Income
Type Amount
TOTAL CO-APPLICANT INCOME
Contingent Liabilities Detail
Contingent Liabilities
To Whom Payable Maximum Liability Collateral Payment Terms: $___ per ____
Schedule 1
Cash, Checking, Savings, Money Market Accounts
Name of Financial Institution Type of Account In Whose Name? Account Balance
TOTAL ACCOUNT BALANCES
Enter on line #1 in the summary as an ASSET.
Schedule 2
Retirement Funds, Profit Sharing, Pension
Financial Institution Type of Account In Whose Name? Account Balance
TOTAL ACCOUNT BALANCES
Enter on line #2 in the summary as an ASSET.
Schedule 3
Securities Owned - Stocks, Bonds, Mutual Funds
No. shares or Bond amount Description Pledged? In Whose Name? Cost Current Value
TOTAL CURRENT VALUE
Enter on line #3 in the summary as an ASSET.
Schedule 4
Life Insurance
Insurance Company Insured Beneficiary Face Value of Policy Cash Value of Policy Loan Amount Against Policy
TOTAL CASH VALUE
Enter on line #4 in the summary as an ASSET.
TOTAL LOAN VALUE
Enter on line #4 in the summary as a LIABILITY.
Schedule 5
Homestead
Address Purchase year Purchase price Market Value Lender Name Interest Rate Maturity Date Monthly Payment Loan Balance
TOTAL MARKET VALUE
Enter on line #5 in the summary as an ASSET.
TOTAL LOAN BALANCE
Enter on line #5 in the summary as a LIABILITY.
Schedule 6
Other Real Estate Owned
Address Purchase year Purchase price Purchase % Market Value Lender Name Interest Rate Monthly Income Monthly Payment Current Balance
TOTAL CURRENT BALANCE
Enter on line #6 in the summary as a LIABILITY.
Schedule 7
Loans/Mortgages Owed To Me
Name of Debtor Description of Property Maturity Date Repayment Terms $___ per ___ Maturity Date Balance Due
TOTAL BALANCE DUE
Enter on line #7 in the summary as an ASSET.
Schedule 8
Auto/Short Term Notes Owed
Lender Name Type: Collateral or Unsecured Interest Rate Maturity Date Payment terms: $___ per ___ Loan Balance
TOTAL REPAYMENT BALANCE
Enter on line #8 in the summary as an ASSET.
TOTAL LOAN BALANCE
Enter on line #8 in the summary as a LIABILITY.
Summary - Assets
Complete from information on above schedules.
#1. Cash (Schedule 1)
#2. Retirement Funds (Schedule 2)
#3. Securities Owned (stocks/bonds) (Schedule 3)
#4. Life Insurance Cash Value (Schedule 4)
#5. Homestead Market Value (Schedule 5)
#6. Other Real Estate (Schedule 6)
#7. Loans/Mortgages Owed to Me (Schedule 7)
#8. Automobiles
Year/Make/Model Amount
#9. Personal Property
#10. Other Tangible Assets
Description Amount
TOTAL ASSETS
Summary - Liabilities
Complete from information on above schedules.
#2. Credit Cards - Current Balance
#4. Life Insurance Loan Value (Schedule 4)
#5. Homestead Loan Balance (Schedule 5)
#6. Mortgages on Other Real Estate (Schedule 6)
#7. Taxes Owed
#8. Auto/Short Term Notes Due (Schedule 8)
Other Liabilities
Description Amount
TOTAL LIABILITIES
Summary - TOTAL
NET WORTH
Total assets minus total liabilities.
Applicant Questionnaire
Have you ever gone through bankruptcy or had a judgment against you?*
- Yes
- No
Are any assets pledged or debts secured except as shown?*
- Yes
- No
Have you made a will?*
- Yes
- No
Are you a guarantor, co-maker or endorser for any debt of an individual, corporation or partnership?*
- Yes
- No
Do you have any outstanding letters of credit or surety bonds?*
- Yes
- No
Are there any suits or legal actions pending against you?*
- Yes
- No
Are you contingently liable on any lease or contract?*
- Yes
- No
Are any of your tax obligations past due?*
- Yes
- No
Co-Applicant Questionnaire
Have you ever gone through bankruptcy or had a judgment against you?*
- Yes
- No
Are any assets pledged or debts secured except as shown?*
- Yes
- No
Have you made a will?*
- Yes
- No
Are you a guarantor, co-maker or endorser for any debt of an individual, corporation or partnership?*
- Yes
- No
Do you have any outstanding letters of credit or surety bonds?*
- Yes
- No
Are there any suits or legal actions pending against you?*
- Yes
- No
Are you contingently liable on any lease or contract?*
- Yes
- No
Are any of your tax obligations past due?*
- Yes
- No
Applicant Attestation
This statement and all supporting schedules, submitted for the purpose of obtaining credit, is true and correct in every detail and fairly shows my/our financial condition at the time indicated. I/we will give you prompt written notice of any subsequent substantial change in such financial condition occurring before discharge of my/our obligations to you. I/we understand that you will retain this personal financial statement whether or not you approve the credit in connection with which it is submitted. You are authorized to check my/our credit and employment history or any other information contained herein.
BY CHECKING THIS BOX I AGREE THE UNDERSIGNED CERTIFY THAT THE INFORMATION CONTAINED ON THIS FORM HAS BEEN CAREFULLY REVIEWED AND THAT IT IS TRUE AND CORRECT IN ALL RESPECTS. THE UNDERSIGNED HAS PROPERLY INDICATED ABOVE THE INTENTIONS OF THIS REQUEST.*
- I AGREE
Name*
First Last
Date*
MM slash DD slash YYYY
Co-Applicant Attestation
This statement and all supporting schedules, submitted for the purpose of obtaining credit, is true and correct in every detail and fairly shows my/our financial condition at the time indicated. I/we will give you prompt written notice of any subsequent substantial change in such financial condition occurring before discharge of my/our obligations to you. I/we understand that you will retain this personal financial statement whether or not you approve the credit in connection with which it is submitted. You are authorized to check my/our credit and employment history or any other information contained herein.
BY CHECKING THIS BOX I AGREE THE UNDERSIGNED CERTIFY THAT THE INFORMATION CONTAINED ON THIS FORM HAS BEEN CAREFULLY REVIEWED AND THAT IT IS TRUE AND CORRECT IN ALL RESPECTS. THE UNDERSIGNED HAS PROPERLY INDICATED ABOVE THE INTENTIONS OF THIS REQUEST.*
- I AGREE
Name*
First Last
Date*
MM slash DD slash YYYY

Name	Age

Name	Age

Type	Amount

Type	Amount

Applicant/Guarantor

Co-Applicant/Co-Signer/Co-Guarantor

Applicant Annual Income

Co-Applicant Annual Income

Contingent Liabilities Detail

Schedule 1

Schedule 2

Schedule 3

Schedule 4

Schedule 5

Schedule 6

Schedule 7

Schedule 8

Summary - Assets

Summary - Liabilities

Summary - TOTAL

Applicant Questionnaire

Co-Applicant Questionnaire

Applicant Attestation

Co-Applicant Attestation

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