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Commercial Term Lending
Personal Financial Statement
201 CTL
09/05/16 JPMorgan Chase Bank, N.A. Page 1 of 3
Important Information About Procedures for Opening a New Account: To help the government fight the funding of terrorism and money laundering activities,
federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for you:
When you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your
driver's license or other identifying documents.
Section 1: Applicant Information
Complete this Personal Financial Statement as Borrower/Principal/Guarantor (“Applicant”) or Co-borrower/Co-Principal/Co-Guarantor (“Co-applicant”) as
applicable. Attach copies of this statement for each additional Co-Applicant.
Applicant Co-Applicant
Legal Name (First, Middle, Last)
Phone Number
Legal Name (First, Middle, Last)
Phone Number
E-Mail Address
E-Mail Address
Social Security Number
Date of Birth
Social Security Number
Date of Birth
Home Address (no P.O. Boxes)
# Years at Address
Home Address (no P.O. Boxes)
# Years at Address
City, State, ZIP Code
Country (if not USA)
City, State, ZIP Code
Country (if not USA)
Marital Status: Married Unmarried Separated
Registered Domestic Partner (RDP) or its equivalent under the
applicable State Law
Marital Status: Married Unmarried Separated
Registered Domestic Partner (RDP) or its equivalent under the
applicable State Law
Occupation
# of Years in Occupation
Occupation
# of Years in Occupation
Primary Source of Income Primary Source of Income
When applicable, check the appropriate box below:
The income or assets of a person other than the Applicant (including the Applicant’s spouse or RDP) will be
used as a basis for loan
qualification, in which case information about that person’s income or assets must be provided; or
The income or assets of the Applicant’s spouse or RDP will not be used as a basis for loan qualification, but the Applicant resides in a
community property state, the security property is located in a community property state, or Applicant is relying on other property located in
a community property state as a basis for repayment of the loan, in which case Lender may request information about the Applicant’s spouse
or RDP, as appropriate.
Any persons, whether married, unmarried, separated, or a RDP may apply for separate credit. Providing joint financial information does not
confirm intent for the two co-applicants to apply for joint credit. Intent to apply for joint credit must be expressly stated. If joint financial condition
is presented, and the intent is for co-applicants to be jointly and severally obligated on the credit (i.e., joint borrowers or guarantors), please initial:
Applicant
Co-Applicant
Initials
Initials
The information provided in this Personal Financial Statement and any supporting schedules (“Statement”) is the most current financial
information available (unless otherwise noted in the date field below) concerning the Applicant or Co-Applicant and there have been no
significant changes in the information provided in this Statement.
The following information (or on the attached financial statement) is a statement of financial condition, as of:
Applicant
/ /
Co-Applicant
/ /
Date
Date
Section 2: Annual Income
Gross Annual Income Applicant Co-Applicant Total
Describe Other Income Notice:
Alimony, child support or separate
maintenance income need not be
disclosed if the Applicant or Co-
Applicant does not wish to have the
income considered as a basis for
repaying this loan.
Base Employment Income
$
$
$
Overtime $ $ $
Commission
$
$
$
Dividends/Interest $ $ $
Net Rental Income
$
$
$
Other Annual Income (see
“Describe Other Income Notice”)
$ $ $
$
$
$
Total Annual Income $ $ $