Since Rent $ Since
Since Rented Since
Since
How Long
Applicant Co-Applicant App. Co-App
Total
SCHEDULE 1 / CASH, SAVINGS, CERTIFICATES AND IRA ACCOUNTS
Acct. Balance
PERSONAL FINANCIAL STATEMENT
Name of Bank or Financial Institution
Type of Account
Total $
Are you a Co-Maker, Endorser or Guarantor of
any other person’s debt?
Are you a defendant in any suit or legal
action?
Have you ever gone through bankruptcy or
had a judgment against you?
Have you made a will?
Annual Income
PLEASE ANSWER EACH QUESTION (Yes / No)
Other (List)
* Income from alimony, child support, or
maintenance payments need not be entered
unless you want it considered as a base for
repayment.
Net Real Estate Income
Dividends/Interest
Salary
Bonuses/Commissions
Please contact your banker if you need assistance with completing these schedules. Round all amounts to the nearest $100.
Mortgages and Contracts Held by You (Schedule 4)
Life Insurance Cash Value (Schedule 3)
Securities (Schedule 2)
Cash (Schedule 1)
ASSETS LIABILITIES
Exchange Funds
Automobile (Describe)
Retirement Accounts, include IRA Accts. (Schedule 1)
Profit Sharing & Pension (Schedule 6)
Other Real Estate (Schedule 5)
Homestead (Schedule 5)
Mortgages on Other Real Estate (Schedule 5)
Mortgages on Home (Schedule 5)
Installment Loans and Contracts (Schedule 7)
Insurance Loans (Schedule 3)
Credit Accounts and Bills Due (Schedule 8)
Short Term Notes Due Financial Insts. (Schedule 7)
Short Term Notes Due to Others (Schedule 7)
(Total Assets Less Total Liabilities)
Net Worth $
Total $
Other Liabilities (Describe)
Taxes
Total $
Other Assets (Describe)
Personal Property
* Do not provide this information if your application is for individual, unsecured credit.
Position/Title Position/Title
Dependents (include self) Dependents (include self)
Marital Status * Unmarried
□ Married □ Separated □ Marital Status * Unmarried □ Married □ Separated □
Address Address
Position/Title Position/Title
Previous Employer Previous Employer
Phone: Residence Work Phone: Residence Work
Employer Employer
Owned Owned
Social Security # Date of Birth Social Security # Date of Birth
Own Own
Previous Address (if less than 5 years at present) Previous Address (if less than 5 years at present)
City/State/Zip City/State/Zip
Street Address Street Address
City/State/Zip City/State/Zip
County County
APPLICANT CO-APPLICANT
Full Name Full Name
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 KPCU, the following statement and
information are furnished as a com
lete, true, and accurate statement of the financial condition of the undersi
ned. All amounts are rounded to the nearest $100.
Rent $
Rented
Since
How Long
