Personal Financial Statement

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General Information
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
Assets (In Even Dollars)
Liabilities and Net Worth (In Even Dollars)
Contingent Liabilities (In Even Dollars)
Schedule A: Banks, Brokers, Savings & Loan Association, Finance Companies or Credit Unions
List the names of all institutions at which you maintain a deposit account and/or where you have loans.  Do not include loans secured by real estate (list real estate loans in Schedule C).
Schedule B: U.S. Government Obligations, Stocks (Listed & Unlisted), Bonds (Government & Commercial)
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
Schedule C1: Homestead
Schedule C2: Other Real Estate Owned (and related debt, if applicable)
 
 
 
 
 
 
 
Schedule D: Accounts and Notes Receivable
YesNo
YesNo
YesNo
YesNo
YesNo
Schedule E: Life Insurance & Annuities
This information is provided for the purpose of obtaining credit for the Applicant(s) or for the purpose of Applicant(s) guaranteeing credit for others. Applicant(s) acknowledge that representations made in this statement will be relied on by the Creditor in its decision to grant such credit. This Statement is true and correct in every detail and accurately represents the financial condition of the Applicant(s) on the date given below. Creditor 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 Applicant(s). Applicant(s)will promptly notify Creditor of any subsequent changes which would affect the accuracy of this Statement. Creditor is further authorized to answer any questions about Creditor’s credit experience with Applicant(s). Applicant(s) are aware that any knowing or willful false statements regarding the value of the above property for purposes of influencing the actions of creditor can be a violation of federal law, 18 U.S.C. &1014, and may result in a fine or imprisonment or both. In addition, each individual signing below authorizes the Creditor to check their individual credit account and employment history and have a credit reporting agency prepare a consumer credit report on them.
PERSONAL CASH FLOW STATEMENT
Monthly Income
Monthly Expenses


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