Fillable Personal-Financial-Statement Personal Financial Statement

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Personal-Financial-Statement Personal Financial Statement

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The Personal-Financial-Statement Personal Financial Statement form is 3 pages long and contains:

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  • 20 check-boxes
  • 168 other fields

Country of origin: US
File type: PDF

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PERSONAL FINANCIAL STATEMENT AS OF: ____/____/____
PERSONAL INFORMATION
APPLICANT (NAME)
CO-APPLICANT (NAME)
Employer and Address
Employer and Address
Business Phone
No. of Years
Title/Position
Business Phone
No. of Years
Title/Position
Previous Employer & Position
No. of Years
Previous Employer & Position
Home Address
Home Address
Home Phone
Social Security No.
Date of Birth
Home Phone
Social Security No.
Date of Birth
Email Address
Email Address
INCOME AND EXPENDITURE STATEMENT FOR THE YEAR ENDED: __________
ANNUAL INCOME SOURCES AMOUNT ($) ANNUAL EXPENDITURES AMOUNT ($)
Salary (applicant)
Federal, State & Other Income Taxes
Salary (co-applicant)
Property Taxes Residential/Investment
Bonuses & Commissions
Rental Payments, Co-Op, or Condo Maintenance
Interest & Dividend Income
Mortgage Payments Residential/Investment
Rental/Real Estate Income
Interest & Principal Payments on Loans
Other Investment Income
Insurance/Medical Expenses
Capital Gains
Alimony/Child Support
Other Income* (Describe Below):
Other Expenses (Describe Below):
TOTAL INCOME ($)
TOTAL EXPENDITURES ($)
* Income from alimony, child support, or other income need not be revealed if the applicant/co-applicant does not wish to have it considered as a basis for repayment.
PERSONAL INFORMATION
Are you a guarantor, co-maker, or endorser for any debt?
Y
☐
N
☐
Are there any suits or legal actions pending against you?
Y
☐
N
☐
Are any of your tax obligations past due?
Y☐
N☐
Are you obligated to pay alimony or child support?
Y
☐
N
☐
Have you or any entity in which you were a major owner ever declared bankruptcy?
Y☐
N☐
Do you have any outstanding letters of credit or surety bonds?
Y☐
N☐
Are you contingently liable on any lease or contract?
Y☐
N☐
Do you have a line of credit or unused credit facility at any other financial institution(s)?
Y☐
N☐
If you answer YES to any of the questions above please attached a separate sheet to provide additional details with dollar amounts.
$ 0
$ 0
BANGOR SAVINGS BANK PERSONAL FINANCIAL STATEMENT • USE ADDITIONAL SHEETS IF NECESSARY
2 Revised 9.2015
BALANCE SHEET AS OF: _____/_____/_____
ASSETS AMOUNT ($) LIABILITIES AMOUNT ($)
Cash Accounts
Real Estate Mortgage Debt (Schedule B)
Marketable Securities (Schedule A)
Life Insurance Loans (Schedule C)
Nonmarketable Securities
Loans Payable to Bank (Schedule E)
Real Estate Owned (Schedule B)
Notes Payable to Others (Schedule E)
Automobiles & Other Personal Property Credit Cards (Schedule E)
Cash Value Life Insurance (Schedule C) Unpaid Taxes
IRA or Other Retirement Account
Partnerships/Other Interests/Corps (Schedule D)
Other Personal Assets (Describe Below): Other Liabilities (Describe Below):
TOTAL ASSETS: TOTAL LIABILITIES:
Net Worth = (Total Assets - Total Liabilities) NET WORTH:
SCHEDULE A - Marketable Securities
(INCLUDING U.S. GOVERMENT AND MUNICIPALS)
Description of Stock or Bond Owner(s) Cost Current Market Value Security for Loan
Y☐
N☐
Y☐
N☐
SCHEDULE B - Personal Residence & Real Estate Investments, Mortgage Debt (INCLUDE HOME EQUITY LOANS)
Property Address Legal Owner
Purchase
Year Price
Market Value
Present Loan
Balance
Monthly
Payment
Lender
SCHEDULE C - Life Insurance
Insurance Company
Face Amount of
Policy
Type of
Policy
Beneficiary
Cash Surrender
Value
Amount
Borrowed
Ownership
SCHEDULE D - Partnerships and S Corporations
Type and Name of Investment
Date of Initial
Investment
Cost % Owned
Current Market
Value
Loans Due
Current Year
Investments
SCHEDULE E - Loans Payable to Banks and Others (INCLUDES CREDIT CARDS, AUTO LOANS, PERSONAL LOANS, ETC.)
Due to Amount Type of Facility Unpaid Balance Interest Rate Monthly Payment Collateral
$ 0
$ 0
$ 0
BANGOR SAVINGS BANK PERSONAL FINANCIAL STATEMENT • USE ADDITIONAL SHEETS IF NECESSARY
3 Revised 9.2015
Representations and Warranties
The information contained in this Personal Financial Statement (hereinafter “PFS”) is provided to induce Bangor Savings Bank (hereinafter “Bank”)
to extend or to continue the extension of credit to the undersigned or to others upon the guarantee of the undersigned. Each undersigned
acknowledges and understands that Bank is relying on the information provided herein in deciding to grant or continue credit or to accept a guarantee
thereof. Each undersigned represents warrants and certifies that the information provided herein is true, correct and complete. Each undersigned
agrees to notify Bank immediately and in writing of any material or adverse change in any of the information contained in this statement. In the
absence of such notice or a new and full written PFS, this should be considered as a continuing statement and substantially correct. If the
undersigned fail to notify Bank as required above, or if any of the information herein should prove to be inaccurate or incomplete in any material
respect, Bank may declare the indebtedness of the undersigned or the indebtedness guaranteed by the undersigned immediately due and payable.
Bank is authorized to make all inquiries Bank deems necessary to verify the accuracy of the information and to determine the credit-worthiness of the
undersigned. Each undersigned authorizes Bank to obtain information concerning each undersigned’s credit standing from time to time, including,
but not limited to, obtaining one or more consumer reports on each undersigned. The undersigned authorize any person or consumer reporting agency
to give you any information it may have on the undersigned. Each of the undersigned authorizes Bank to answer questions about Bank’s credit
experience with the undersigned. As long as any obligation or guarantee of the undersigned to Bank is outstanding, the undersigned shall supply
annually an updated financial statement.
Your Signature Date
Co-Applicant’s Signature Date
(if you are requesting the financial accommodation jointly)
Use this space to provide additional information or detail.
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Personal-Financial-Statement Personal Financial Statement

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Completed 3 July 2020

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