Personal Financial Statement (Page 6 of 6) in pdf

Personal Financial Statement Page 6

Secured or

Current

Monthly

Name & Address of Lender

Credit in the Name of

Collateral Description

Unsecured?

Balance

Payment

Total

Schedule H - Accounts And Bills Payable (Including Credit Cards)

Monthly

Payable To

Account Number

Persons Liable

Current Balance

Payment

Total

Schedule I - Other Liabilities

Monthly

Payable To

Collateral

Persons Liable

Current Balance

Payment

Total

I (we) hereby affirm that the foregoing information contained in this financial statement is presented for the purpose of obtaining credit as of the date

indicated and is true, complete and correct. I understand Lender is relying on this statement of my financial condition in making loan(s) to me. Lender is

authorized to make any investigation of my credit or employment status either directly or through any agency employed by lender for that purpose. I agree to

inform Lender immediately of any matter which will cause any signficiant change in my/our financial condition. I understand that Lender will retain this

financial statement whether or not credit is granted.

Signature (Individual)

SSN:

DOB:

SSN:

DOB:

_____________________ , 2_____

____________________, 2_________

Date Signed:

Personal Financial Statement 08/25/2016

Member FDIC

HNB NMLS 527730