"Personal Financial Statement Template"

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Personal Financial Statement
Section 1: Applicant Information
Section 2: Co-Applicant
Information*
Name
Name
Date of Birth
Social Security Number
Date of Birth
Social Security Number
Residence Address
Residence Address
City
State
Zip
City
State
Zip
Position/Occupation
Number of Years
Position/Occupation
Number of Years
Employer Name
Employer Name
Residential Telephone
Business Telephone
Residential Telephone
Business Telephone
Nearest Relative Not Living With Me
Relationship
Telephone
Nearest Relative Not Living With Me
Relationship
Telephone
Address
Address
City
State
Zip
City
State
Zip
Driver’s License/ID Number
Expiration Date
Date Issued
State Issued
Driver’s License/ID Number
Expiration Date
Date Issued
State Issued
*When completed and signed denotes your intent to apply for joint credit.
Section 3: Statement of Financial Condition as of
Indicate “A” (Applicant), “C” (Co-Applicant), or “J” (Jointly Held With Others) in column next to assets and liabilities listed to indicate to whom item applies.
ASSETS
A, C or J
Dollar Amount
LIABILITIES
A, C or J
Dollar Amount
Cash on Hand and In Banks (Schedule A)
Secured Notes Payable to Banks (Schedule E)
IRAs, 401(k), Retirement Assets
Unsecured Notes Payable to Banks (Schedule E)
U.S. Gov’t, Marketable Securities (Schedule B)
Due to Brokers, Margin Loans (Schedule E)
Securities Held By Broker in Margin Accounts
Amounts Payable To Others (Secured)
Restricted/Control Stocks (Public Company Only)
Credit Cards (Schedule E)
Real Estate Owned (Schedule C)
Equity Lines (Schedule E)
Loans Receivable
Unpaid Taxes (Income, Property, etc.)
Life Insurance Cash Value (Schedule D)
Real Estate Mortgages Payable (Schedule C)
Value of Closely Held Business
Other Debts (itemize)
Vehicles/Other Personal Property
Other Assets (itemize)
TOTAL LIABILITIES
$0.00
NET WORTH
$0.00
TOTAL ASSETS
$0.00
TOTAL: LIABILITIES AND NET WORTH
$0.00
INCOME FOR YEAR ENDED:
Applicant
Co-Applicant
EXPENSES
Salary
Rent (Payment)
Bonuses and Commissions
Alimony
Interest and Dividends
Child Support
Rental Income
Tuition
PERSONAL INFORMATION (Both Applicant and Co-Applicant)
Other Income (Alimony/child support need not be
revealed if you do not wish to have it considered
Are you a U.S. Citizen?
Yes
No
as a basis for repaying this obligation.)
TOTAL INCOME
$0.00
$0.00
Are you an officer or an immediately family member/dependent
Yes
No
CONTINGENT LIABILITIES
of an officer of a SunTrust Banks, Inc. controlled entity?
Do you have contingent liabilities? If Yes, describe:
Do you have a will?
Yes
No
If Yes
Executor Name:
Are you a partner or officer in another venture?
Yes
No
If Yes,
Describe:
Income tax settled through (date)
Are any assets pledged other than as described on schedules?
Yes
No
If Yes,
As endorser, co-maker or guarantor?
On leases or contracts?
Describe:
Are you a defendant in any suits or legal actions?
Yes
No
If Yes,
Legal claims
Other special debt
Describe:
Amount of contested income tax liens
Have you or your businesses ever been declared bankrupt?
Yes
No
COMPLETE THE SCHEDULES ON THE NEXT PAGE AND PROVIDE SIGNATURE.
317943 (10/08)
Page 1 of 2
SunTrust Corporate Forms
Personal Financial Statement
Section 1: Applicant Information
Section 2: Co-Applicant
Information*
Name
Name
Date of Birth
Social Security Number
Date of Birth
Social Security Number
Residence Address
Residence Address
City
State
Zip
City
State
Zip
Position/Occupation
Number of Years
Position/Occupation
Number of Years
Employer Name
Employer Name
Residential Telephone
Business Telephone
Residential Telephone
Business Telephone
Nearest Relative Not Living With Me
Relationship
Telephone
Nearest Relative Not Living With Me
Relationship
Telephone
Address
Address
City
State
Zip
City
State
Zip
Driver’s License/ID Number
Expiration Date
Date Issued
State Issued
Driver’s License/ID Number
Expiration Date
Date Issued
State Issued
*When completed and signed denotes your intent to apply for joint credit.
Section 3: Statement of Financial Condition as of
Indicate “A” (Applicant), “C” (Co-Applicant), or “J” (Jointly Held With Others) in column next to assets and liabilities listed to indicate to whom item applies.
ASSETS
A, C or J
Dollar Amount
LIABILITIES
A, C or J
Dollar Amount
Cash on Hand and In Banks (Schedule A)
Secured Notes Payable to Banks (Schedule E)
IRAs, 401(k), Retirement Assets
Unsecured Notes Payable to Banks (Schedule E)
U.S. Gov’t, Marketable Securities (Schedule B)
Due to Brokers, Margin Loans (Schedule E)
Securities Held By Broker in Margin Accounts
Amounts Payable To Others (Secured)
Restricted/Control Stocks (Public Company Only)
Credit Cards (Schedule E)
Real Estate Owned (Schedule C)
Equity Lines (Schedule E)
Loans Receivable
Unpaid Taxes (Income, Property, etc.)
Life Insurance Cash Value (Schedule D)
Real Estate Mortgages Payable (Schedule C)
Value of Closely Held Business
Other Debts (itemize)
Vehicles/Other Personal Property
Other Assets (itemize)
TOTAL LIABILITIES
$0.00
NET WORTH
$0.00
TOTAL ASSETS
$0.00
TOTAL: LIABILITIES AND NET WORTH
$0.00
INCOME FOR YEAR ENDED:
Applicant
Co-Applicant
EXPENSES
Salary
Rent (Payment)
Bonuses and Commissions
Alimony
Interest and Dividends
Child Support
Rental Income
Tuition
PERSONAL INFORMATION (Both Applicant and Co-Applicant)
Other Income (Alimony/child support need not be
revealed if you do not wish to have it considered
Are you a U.S. Citizen?
Yes
No
as a basis for repaying this obligation.)
TOTAL INCOME
$0.00
$0.00
Are you an officer or an immediately family member/dependent
Yes
No
CONTINGENT LIABILITIES
of an officer of a SunTrust Banks, Inc. controlled entity?
Do you have contingent liabilities? If Yes, describe:
Do you have a will?
Yes
No
If Yes
Executor Name:
Are you a partner or officer in another venture?
Yes
No
If Yes,
Describe:
Income tax settled through (date)
Are any assets pledged other than as described on schedules?
Yes
No
If Yes,
As endorser, co-maker or guarantor?
On leases or contracts?
Describe:
Are you a defendant in any suits or legal actions?
Yes
No
If Yes,
Legal claims
Other special debt
Describe:
Amount of contested income tax liens
Have you or your businesses ever been declared bankrupt?
Yes
No
COMPLETE THE SCHEDULES ON THE NEXT PAGE AND PROVIDE SIGNATURE.
317943 (10/08)
Page 1 of 2
SunTrust Corporate Forms
SCHEDULE A: Cash and Investments
Account Type
Bank/Broker Name
In Name Of
Pledged?
Current Balance
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
TOTAL
$0.00
SCHEDULE B: U.S. Government and Marketable Securities
Number of Shares
Description
In Name Of
Pledged?
Date of Value
Value
Yes
No
Yes
No
Yes
No
Yes
No
TOTAL
$0.00
SCHEDULE C: Real Estate Owned
(2) Property Description
Type: Commercial (C), Residential (R), Agricultural (A).
(1)
(3)
(4)
(5)
Use: Home, Lot, Office, Rental, Warehouse.
Property Address
Cost
Date Acquired
Current Market Value
Size: Square Footage.
Type
Use
Size
1
2
3
4
5
6
GRAND TOTAL
$0.00
(8)
(9)
(10)
(11)
(6)
(7)
Mortgage
Monthly
Monthly Rental
Ownership
Lender Name
Name on Title
Balance
Payment
Income
Percentage
1
%
2
%
3
%
4
%
5
%
6
%
GRAND TOTAL
$0.00
SCHEDULE D: Life Insurance Carried (Including Whole Life and Group Insurance)
Insurance Company Name
Policy Owner
Beneficiary
Face Amount
Policy Loans
Cash Surrender Value
TOTAL
$0.00
SCHEDULE E: Banks/Finance Companies Where Credit Has Been Obtained
Maximum
Monthly
Current
Type
Lender Name
Collateral Description
Maturity
Line Amount
Payment
Balance
(Line of Credit, Term Loan)
TOTAL
$0.00
It is my/our intent to apply for individual/joint credit. Therefore, each of the undersigned hereby instructs, consents and authorizes SunTrust Bank, or any affiliate, subsidiary or
other entity related thereto (“Lender”) to obtain a consumer credit report and any other information relating to their individual credit status in the following circumstances: (a) relating
to the opening of an account or upon application for a loan or other product or service offered by Lender by a commercial entity of which the undersigned is a principal, member,
guarantor or other party, (b) thereafter, periodically according to the Lender’s credit review and audit procedures, and (c) relating to Lender’s review or collection of a loan, account,
or other Lender product or service made or extended to a commercial entity of which the undersigned is a principal, member, guarantor or other party.
Each of the undersigned certify that everything stated on the first page and second page of this Personal Financial Statement and any other documents or information submitted
in connection with this Personal Financial Statement is true, accurate and complete. Each of the undersigned understands that Lender will retain this Personal Financial Statement.
Each of the undersigned hereby authorize Lender to verify at any time any information submitted to Lender by or on behalf of the undersigned; obtain further information concerning
the credit standing of the undersigned, including without limitation, credit and employment history; and exchange credit information concerning the undersigned with other individuals
or entities, including, without limitation, any affiliate, subsidiary or other entity related to SunTrust Bank. Each of the undersigned authorize Lender to consider this Personal Financial
Statement as a continuing statement of financial condition until replaced by a new Personal Financial Statement or until the undersigned specifically notifies Lender in writing of any
change in such financial condition.
This Personal Financial Statement, including the consent to obtain consumer credit report contained above is executed by the undersigned(s) on the date(s) listed below.
Applicant Signature
(Required)
Co-Applicant Signature
(Required if Section 2 is Completed)
Print Name
Date Signed
Print Name
Date Signed
317943 (10/08)
Page 2 of 2
SunTrust Corporate Forms
Page of 2