Personal Financial Statement

Name Date of Birth Date of Financial Statement Email Cell Phone# SSN Street Address City State Zip Code Home Phone#

Own Home Renting Other

Mortgage Payment or Rent Name & Address of Employer Title/Position Length of Employment Business Phone # # of Dependants Name of Spouse Date of Birth Social Security Number Name & Address of Employer Title/Position Length of Employment Business Phone #

Individual Credit. If a married applicant is applying for individual credit, complete this statement including all marital property and all individual property of the applicant, but do not include individual property of the non-applicant spouse. Include all liabilities of both spouses. Joint Credit with spouse as joint applicant. If married applicants are applying for joint credit, include all assets and all liabilities of both spouses. Both spouses must sign this statement. Joint Credit

Joint Credit Name

Joint applicant who is not your spouse. If a married applicant is applying for joint credit with someone other than his or her spouse, each applicant must complete a separate statement as if applying for individual credit, including all marital property and all individual property of the applicant. Do not include any individual property of the non-applicant spouse. Include all liabilities of the applicant and the applicant's spouse. Only the applicant must sign this statement.

List of Assets	Amount
Cash in FNB Giddings	Amount
Cash in other institutions (list)	Amount
Stocks & Bonds Owned (Schedule 1)	Amount
IRA / Keogh / Pension Amounts	Amount
Accounts / Notes Receivable (Schedule 2)	Amount
Deeds of Trusts Owned (Schedule 2)	Amount
Real Estate Market Value(s) (Schedule 3)	Amount
Other Investments / Partnerships	Amount
Automobiles	Amount
Personal Property	Amount
Other Assets (attach detail)	Amount
Total Assets	Total Assets

List of Liabilities	Amount Owed	Monthly Payment
Income Taxes Payable	Amount Owed	Monthly Payment
Other Taxes Payable	Amount Owed	Monthly Payment
Charge Cards Payable (Schedule 4)	Amount Owed	Monthly Payment
Installment Loans (Schedule 4)	Amount Owed	Monthly Payment
Loans on Life Insurance	Amount Owed	Monthly Payment
Loans on Stocks & Bonds	Amount Owed	Monthly Payment
Real Estate Indebtedness (Schedule 3)	Amount Owed	Monthly Payment
Other Liabilities (List)	Amount Owed	Monthly Payment

Total Payments	Monthly Payment
Total Liabilities	Amount Owed
Net Worth (Assets-Liabilities)	Amount Owed
Total Liabilities + Net Worth

Annual Income	Amount
Applicant Salary	Amount
Spouse's Salary	Amount
Dividend / Bond Income	Amount
Interest Income	Amount
Rental Income	Amount
Other (Detail)	Amount
Total Income:	Total Income

Annual Expenses	Amount
Interest Expense	Amount
Property Taxes	Amount
Income & Other Taxes	Amount
Mortgage Payments/Rent	Amount
Credit Card Payments	Amount
Loan Payments	Amount
Insurance	Amount
Alimony, Child Support	Amount
Other (Detail)	Amount
Total Expenses:	Total Expenses

Contingent Liabilities	Amount
As an Endorser	Amount
As a Guarantor	Amount
As a Co-signer	Amount
On Damage Claims	Amount
Letters of Credit	Amount
Other (Detail)	Amount
Total Liabilities:	Total Liabilities

General Information - If you are married, these questions apply to both you and your spouse.

Are any assets heldin Trust? Yes No

Are any assets pledged or debts secured except as shown? Yes No

Have you ever had a repossession? Yes No

Have you been declared bankrupt in the last 10 years? Yes No

If yes, what year?

Have you ever been a principal or guarantor of a firm that declared bankruptcy? Yes No

If yes, what year?

Are there any unsatisfied judgments against you? Yes No

Are you a party to any claim or law suit? Yes No

Has there been an IRS audit in the past 3 years? Yes No

If yes, has the audit been settled? Yes No

If yes to any of the above, please explain.

Schedule 1: Marketable Securities:

Indicate: [J] for joint with spouse [O] for joint with other than spouse [A] for applicant's separate property [S] for spouse's separate property

Are any of your Securities Restricted? Yes No

Do you own 10% or more of the outstanding stock of any company? Yes No

Marketable Security

How Held # of Shares or Bond Amount Description Title In Name Of Pledged Present Market Value

Total Present Market Value

Schedule 2: Notes Receivable - Mortgage & Deed of Trust Owned

Indicate: [J] for joint with spouse[O] for joint with other than spouse [A] for applicant's separate property[S] for spouse's separate property

Notes Receivable - Mortgage & Deed of Trust Owned

How Held Name of Debtor Collateral Date of Note Monthly Payment Maturity Date Unpaid Balance

Total Unpaid Balance

Schedule 3: Real Estate Holdings - Mortgages or Lines

Indicate: [J] for joint with spouse[O] for joint with other than spouse [A] for applicant's separate property[S] for spouse's separate property

Indicate Type:[SD] for Single Dwelling[MD] for Multiple Dwelling or[C] for Commercial/Industrial

Real Estate Holdings - Mortgages or Lines

Property Address How Held Type Date Purchased Mrkt. Value Orig. Cost % Owned 1st Mortgage Monthly Payment Name of Lender 2nd Mortgage Monthly Payment Name of Lender

Total Owed Total Pmts

Schedule 4: Credit Cards And Loans Payable

Credit Cards And Loans Payable

Name of Creditor Monthly Payment Current Balance

Total Monthly Payment Total Current Balance

I certify that all information provided by me herein, including attachments (s) is true, correct and complete. I authorize FNB Giddings 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 FNB Giddings to provide credit information about its credit experience with me to other creditors and credit reporting agencies. I agree to provide any further information the Bank might require to process my application.

Applicant's Signature Date Spouse's Signature (only if applying for joint credit) Date I certify the information above is correct and ready for submission.