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PFS for CONFIDENTIAL Page 1 of 3
PERSONAL FINANCIAL STATEMENT
Bank:
You may apply for an extension of credit individually or jointly with another applicant. This statement and any applicable supporting schedules may be
completed jointly by co-applicants if their assets and liabilities can be meaningfully and fairly presented on a combined basis, otherwise separate
statements and schedules must be provided. If you are applying for an unsecured individual loan, you do not need to complete any information
concerning a co-applicant unless another person will be permitted to use the account or you wish the co-applicant’s or other person’s income to be relied
upon as the basis for repayment. For the purpose of obtaining credit from time to time with the bank, the following statement and information are
furnished as a complete, true, and accurate statement of the financial condition of the undersigned on . All amounts are rounded to the nearest
$100.
APPLICANT CO-APPLICANT
Full Name
Full Name
Street Address
Street Address
City/State/Zip
City/State/Zip
County
County
Since
Own Rent
$
Since
Own Rent
$
Previous Address (if less than 5 years at present)
Previous Address (if less than 5 years at present)
City/State/Zip
City/State/Zip
Since
Owned Rented Since
Owned Rented
Social Security #
Date of Birth
Social Security #
Date of Birth
Phone: Residence
Work
Phone: Residence
Work
Employer
Employer
Address
Address
Position/Title
Since
Position/Title
Since
Previous Employer
Previous Employer
Position/Title
How Long
Position/Title
How Long
Dependents (include self)
Dependents (include self)
Marital Status *
Unmarried Married Separated
Marital Status *
Unmarried Married Separated
* Do not provide this information if your application is for individual, unsecured credit.
ASSETS LIABILITIES
Cash (Schedule 1)
Short Term Notes Due Financial Insts. (Schedule 7)
Securities (Schedule 2)
Short Term Notes Due to Others (Schedule 7)
Life Insurance Cash Value (Schedule 3)
Credit Accounts and Bills Due (Schedule 8)
Mortgages and Contracts Held by You (Schedule 4)
Insurance Loans (Schedule 3)
Homestead (Schedule 5)
Installment Loans and Contracts (Schedule 7)
Other Real Estate (Schedule 5)
Mortgages on Home (Schedule 5)
Profit Sharing & Pension (Schedule 6)
Mortgages on Other Real Estate (Schedule 5)
Retirement Accounts, include IRA Accts. (Schedule 1)
Taxes
Automobile (Describe)
Other Liabilities (Describe)
Personal Property
Other Assets (Describe)
Total $
0
Total $
0
(Total Assets Less Total Liabilities) Net Worth $
0