Personal Financial Statement

Are you completing as an individual or joint?

1st Indivdual

Housing Status

Housing Status Options


Employment Status

2nd Individual


Employment Status


Schedule 1: Cash & Deposits

Schedule 2: Marketable Securities

Marketable Securities

Schedule 3:Net Worth of Businesses Owned

Schedule 4: IRA / Retirement / Pension Amounts

Schedule 5: Real Estate Holdings - Mortgages or Liens

Mortgage or Lien

Schedule 6: Other Accounts

Account Name Total Value

Schedule 7: Automobiles

Description Total Value

Schedule 8: Additional/Other Assets


Schedule 9: Credit Cards And Loans Payable

*Excludes any Mortgage debt

Credit Card or Loan Payable

Name of Creditor Monthly Payment Current Balance

Other Liabilities

Description Amount Owed Monthly Payment
Liability Amount Owed
Income Taxes Payable
Other Taxes Payable
Loans on Life Insurance
Other Real Estate Debt

Annual Income

Will the Alimony & Child Support Income continue for the next 5 years?

Other Income

Description Annual Total

Annual Expenses

Other Expenses

Description Annual Total

Contingent Liabilities

Description Total Amount

Liability / Assets/ Net Worth

General Information

If you are co-applying, these questions apply to both you and your spouse.

Are any assets held in Trust?
Have you ever had a repossession?
Have you ever had a bankruptcy or had a judgment against you?
Have you ever been a principal or guarantor of a firm that declared bankruptcy?
Are you a party to any claim or lawsuit?
Has there been an IRS audit in the past 3 years?
If yes, has the audit been settled?


I certify that all information provided by me herein, including attachments (s) is true, correct and complete. I authorize Bank Name to make whatever inquiries about me you deem necessary and appropriate for the purpose of evaluating my credit, including obtaining credit reports and contacting my employer. I also authorize Bank Name to provide credit information about its credit experience with me to other creditors and credit reporting agencies. I authorize the Bank to obtain address information from the Department of Motor Vehicles and waive the address confidentiality requirements of the State Vehicle Code. I agree to provide any further information the Bank might require to process my application.

Back to Top