Personal Financial Statement Form
Download a blank fillable Personal Financial Statement Form in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Personal Financial Statement Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2PERSONAL FINANCIAL STATEMENT
CONFIDENTIAL
STATEMENT OF_____________________________________________________________________________________________
OCCUPATION____________________________________ADDRESS__________________________________________________
BORROWER 1: DATE OF BIRTH_____________________________SOCIAL SECURITY NO.___________________________
HOME PHONE_____________________________________ WORK PHONE____________________________________________
BORROWER 2: DATE OF BIRTH_____________________________SOCIAL SECURITY NO.___________________________
HOME PHONE_____________________________________ WORK PHONE____________________________________________
TO THE CANANDAIGUA NATIONAL BANK AND TRUST CO., CANANDAIGUA, NY
Member Federal Reserve System
F
or the purpose of procuring credit from time to time with you, I represent and warrant that the following is a true and accurate statement of my fi nancial condition on
____________________________, 20____, with the understanding that the Offi cers of the Bank in granting me credit, rely upon the accuracy of this statement; and further, whenever
my fi nancial condition is changed materially from the fi nancial conditions shown in the following statement, I agree to give said Bank immediate written notice of such change, whether
applications for further loans are made or not; in the absence of such notice or of a new and complete written statement, the following statement may be considered as a continuing state-
ment and substantially correct and upon applications for further credit or renewals or extensions of credits previously extended I do hereby represent and warrant that the Offi cers of
said Bank may rely upon this statement as a true and accurate statement of my fi nancial condition at the time such further credit or renewal or extension of previous credits is requested.
JOINTLY OWNED ASSETS AND LIABILITIES ARE MARKED WITH A “J”
ASSETS
US DOLLARS
LIABILITES
US DOLLARS
Cash on hand in Banks
$
Total of Outstanding Accounts Payable
$
Name of Banks:
Balance Due on Installment Loans
$
Accounts Receivable (collectible)
$
Notes Payable Cdga. Natl. Bank & Tr. Co.
$
Notes Receivable (collectible)
$
Notes Payable Other Banks
$
Readily Marketable Securities
$
Notes Payable Others
$
Readily Marketable Securities Pledged
$
Due to Insurance Co’s on Policy Loans
$
Cash Value Life Insurance (Not Face Value)
$
Due Brokers on Securities
$
Other Quick Assets (Itemize)
$
Real Estate and Other Taxes Unpaid
$
$
Other Current Liabilities (Itemize)
$
$
$
$
$
Total of Current Assets
$
0
Total of Current Liabilities
$
0
Real Estate (see schedule)
$
Mortgages on Real Estate (see schedule)
$
Furniture, Automobiles, Etc.
$
Other Deferred Liabilites (Itemize)
1
$
Investments not Quickly Saleable
$
$
Other Assets (Itemize)
$
$
$
$
Total Non-Current Liabilities
$
$
0
$
TOTAL LIABILITES
$
0
Total Non-Current Assets
0
$
0
NET WORTH
$
TOTAL
$
0
TOTAL
$
0
STATEMENT OF INCOME
Annual Income from Salary Per W-2
$
Annual Income from other Sources - List and describe each source separately. Attach additional sheet if necessary.
$
$
OPTIONAL
Alimony or child support or separate maintenance payments are optional information
ADDITIONAL
and need not be revealed if the applicant does not choose to rely on such income
0
INCOME
in applying for credit.
$_________________
TOTAL
$
PURPOSE OF THE LOAN
Business
Personal
AMOUNT OF LOAN
State Purpose:
$
I/We authorize and instruct any person or consumer reporting agency to compile and furnish to the Bank any information it may have or obtain in response to such credit inquiries and agree that same shall remain your property
whether or not credit is extended.
All information set forth in this application is declared to be a true representation of facts made for the purpose of obtaining the credit requested and any willful misrepresentation of this application could result in criminal action.
The bank may request a consumer report in connection with this application and subsequent consumer reports in connection with updating, renewing or extending the existing or future extensions of credit. Upon your written
request, we will provide the name and address of the consumer agency furnishing such reports to us, if any.
THE FORGOING STATEMENT HAS BEEN FILLED IN BY ME OR FROM INFORMATION FURNISHED BY ME, AND I KNOW THE CONTENTS THEROF.
Signed this ____________day of____________________20________
Signature_______________________________________________________
(OVER)
Signature_______________________________________________________
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial