Va Form 26-6807 - Financial Statement
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4OMB Approved No. 2900-0047
Respondent Burden 45 Minutes
1. FILE NO.
2. LOAN NO.
FINANCIAL STATEMENT
C-
IMPORTANT: Type or print all entries in ink. If more space is needed for any item, continue under Section VI, "Remarks," or attach separate sheets. If there is a
co-borrower or co-applicant who is not the spouse of the borrower/applicant, a separate financial statement should be completed by that person.
SECTION I - GENERAL INFORMATION
5. DATE OF BIRTH
3. NAME AND PRESENT ADDRESS OF BORROWER/APPLICANT
4. HOME TELEPHONE NO.
(Include Area Code)
(Include ZIP Code)
6. MARITAL STATUS OF BORROWER/APPLICANT
7. SOCIAL SECURITY NO. OF
BORROWER/APPLICANT
8. NAME OF SPOUSE
9. SPOUSE'S DATE
10. SOCIAL SECURITY NO. OF
11. AGE(S) OF DEPENDENT(S)
OF BIRTH
SPOUSE
INITIALS
INITIALS
13A. CO-BORROWER/SPOUSE: If you do not wish to
12A. BORROWER/APPLICANT: If you do not wish to
complete Items 13B and 13C please initial here
complete Items 12B and 12C, please initial here
(NOTE: Information not to be collected on a non-
coborrower spouse)
12B. RACE/NATIONAL ORIGIN
12C. SEX
13B. RACE/NATIONAL ORIGIN
13C. SEX
AMERICAN INDIAN
AMERICAN INDIAN
HISPANIC
HISPANIC
MALE
MALE
ALASKA NATIVE
ALASKA NATIVE
(Not Hispanic)
BLACK
(Not Hispanic)
FEMALE
BLACK
FEMALE
ASIAN PACIFIC
ASIAN PACIFIC
(Not Hispanic)
ISLANDER
ISLANDER
WHITE
(Not Hispanic)
WHITE
14. PLEASE CHECK THE APPROPRIATE BOX(ES). IF ONE OR MORE ARE CHECKED, THIS CREDIT STATEMENT MUST INCLUDE INFORMATION CONCERNING THE
BORROWER/APPLICANT'S SPOUSE (OR FORMER SPOUSE IF BOX "D" IS CHECKED). IF NO BOXES ARE CHECKED, NO INFORMATION CONCERNING THE
SPOUSE NEED BE FURNISHED.
C.
THE BORROWER/APPLICANT IS MARRIED AND THE PROPERTY SECURING THE
A.
THE SPOUSE IS OR WILL BE JOINTLY OBLIGATED WITH THE
LOAN IS LOCATED IN A COMMUNITY PROPERTY STATE.
BORROWER/APPLICANT ON THE LOAN.
D.
THE BORROWER/APPLICANT IS RELYING ON ALIMONY, CHILD SUPPORT, OR
B.
THE BORROWER/APPLICANT IS RELYING ON THE SPOUSE'S
SEPARATE MAINTENANCE PAYMENTS FROM A SPOUSE OR FORMER SPOUSE
INCOME AS A BASIS FOR REPAYMENT OF THE LOAN.
AS A BASIS FOR REPAYMENT OF THE LOAN.
SECTION II - EMPLOYMENT AND FINANCIAL STATUS
15. COMPLETE RECORD OF EMPLOYMENT FOR YOURSELF AND SPOUSE (Start with present position and work back 2 years)
(Month, year)
B. DATES
C. KIND OF JOB
D. WORK
A. NAME AND ADDRESS OF EMPLOYER
TELEPHONE NO.
(Mechanic, stenographer, etc.)
FROM
TO
(1)
PRESENT
TIME
BORROWER
/APPLICANT
(2)
(1)
PRESENT
TIME
SPOUSE
(2)
VA FORM
EXISTING STOCKS OF VA FORM 26-6807, SEP 2003,
26-6807
OCT 2004
WILL BE USED.
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