Since Rent $ Since
Since Rented Since
Since
How Long
Applicant Co-Applicant App. Co-App
Total
SCHEDULE 1 / CASH, SAVINGS, CERTIFICATES AND IRA ACCOUNTS
Acct. Balance
PERSONAL FINANCIAL STATEMENT
Name of Bank or Financial Institution
Type of Account
Total $
Are you a Co-Maker, Endorser or Guarantor of
any other person’s debt?
Are you a defendant in any suit or legal
action?
Have you ever gone through bankruptcy or
had a judgment against you?
Have you made a will?
Annual Income
PLEASE ANSWER EACH QUESTION (Yes / No)
Other (List)
* Income from alimony, child support, or
maintenance payments need not be entered
unless you want it considered as a base for
repayment.
Net Real Estate Income
Dividends/Interest
Salary
Bonuses/Commissions
Please contact your banker if you need assistance with completing these schedules. Round all amounts to the nearest $100.
Mortgages and Contracts Held by You (Schedule 4)
Life Insurance Cash Value (Schedule 3)
Securities (Schedule 2)
Cash (Schedule 1)
ASSETS LIABILITIES
Exchange Funds
Automobile (Describe)
Retirement Accounts, include IRA Accts. (Schedule 1)
Profit Sharing & Pension (Schedule 6)
Other Real Estate (Schedule 5)
Homestead (Schedule 5)
Mortgages on Other Real Estate (Schedule 5)
Mortgages on Home (Schedule 5)
Installment Loans and Contracts (Schedule 7)
Insurance Loans (Schedule 3)
Credit Accounts and Bills Due (Schedule 8)
Short Term Notes Due Financial Insts. (Schedule 7)
Short Term Notes Due to Others (Schedule 7)
(Total Assets Less Total Liabilities)
Net Worth $
Total $
Other Liabilities (Describe)
Taxes
Total $
Other Assets (Describe)
Personal Property
* Do not provide this information if your application is for individual, unsecured credit.
Position/Title Position/Title
Dependents (include self) Dependents (include self)
Marital Status * Unmarried
Married Separated Marital Status * Unmarried Married Separated
Address Address
Position/Title Position/Title
Previous Employer Previous Employer
Phone: Residence Work Phone: Residence Work
Employer Employer
Owned Owned
Social Security # Date of Birth Social Security # Date of Birth
Own Own
Previous Address (if less than 5 years at present) Previous Address (if less than 5 years at present)
City/State/Zip City/State/Zip
Street Address Street Address
City/State/Zip City/State/Zip
County County
APPLICANT CO-APPLICANT
Full Name Full Name
You may apply for an extension of credit individually or jointly with another applicant. This statement and any applicable supporting schedules may be completed jointly by co-applicants
if their assets and liabilities can be meaningfully and fairly presented on a combined basis, otherwise separate statements and schedules must be provided. If you are applying for an
unsecured individual loan, you do not need to complete any information concerning a co-applicant unless another person will be permitted to use the account or you wish the co-
applicant’s or other person’s income to be relied upon as the basis for repayment. For the purpose of obtaining credit from time to time with KPCU, the following statement and
information are furnished as a com
p
lete, true, and accurate statement of the financial condition of the undersi
g
ned. All amounts are rounded to the nearest $100.
Rent $
Rented
Since
How Long
SCHEDULE 2 / SECURITIES OWNED
Par Value or No.
of Shares
SCHEDULE 3 / LIFE INSURANCE
SCHEDULE 4 / RECEIVABLES DUE TO ME ON MORTGAGES AND CONTRACTS I OWN
SCHEDULE 5 / REAL ESTATE OWNED
Property
Description
Year
Acquired
Mortgage
Balance
Date of
Maturity
Insurance Co.: Agent:
SCHEDULE 6 / PROFIT SHARING AND PENSION
SCHEDULE 7 / INSTALLMENTS, CREDIT LINES AND NOTES
SCHEDULE 8 / CREDIT ACCOUNTS, BILLS DUE, ALIMONY/CHILD SUPPORT, DAYCARE, ETC.
Applicant’s Signature Date Co-Applicant’s Signature Date
Description Current Market Value
Insured Beneficiary
Registered in Name(s) of Listed or Unlisted
Loans Face Value of Policy
First Lien or Second
Lien
Cash Value of Policy
Insurance Company
Total $
Total $
Total $
Date of Maturity Balance Due
per
per
per
Repayment Terms Description of Property Name of Debtor
Name of Creditor
Monthly Payment
Current Market
Value
Purchase Price
Total $
Total $
Amount Totally Vested
Account Balance Loans
Name of Institution
Type of Account
Repayment Terms
Date of Maturity
Collateral Name of Creditor
Balance Due
Total $
per
per
Repayment Terms Name of Company
per
per
per
You certify that the information provided in this statement is true and correct. So long as you owe any sums to KPCU, you agree to give KPCU prompt
written notice of any material change in your financial condition and, upon request, you agree to provide KPCU with an updated personal financial statement.
KPCU is authorized to retain this personal financial statement whether or not credit is approved and is further authorized to verify your credit and
employment history or any other information in this statement. This application does not obligate KPCU to make any loan even if you meet the normal
standards KPCU considers in determining whether to approve or deny the application. KPCU is KeyPoint Credit Union.
Balance Due
per
per
per
per
Total $
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