Personal Financial Statement - Bangor Savings Bank
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1
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3PERSONAL 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
No. of Years
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
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Are you a guarantor, co-maker, or endorser for any debt?
Y
N
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Are there any suits or legal actions pending against you?
Y
N
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Are any of your tax obligations past due?
Y
N
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Are you obligated to pay alimony or child support?
Y
N
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Have you or any entity in which you were a major owner ever declared bankruptcy?
Y
N
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Do you have any outstanding letters of credit or surety bonds?
Y
N
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Are you contingently liable on any lease or contract?
Y
N
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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.
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