Personal Financial Statement

Personal Financial Statement
Date

MonthDayYear
Date
Type of Credit

Applicant Information
Name

First NameLast Name
Social Security
Birthdate

MonthDayYear
Date
Home Address

Address

Street Address Line 2

CityState

Zip Code
Email
example@example.com
Phone
Format: (000) 000-0000.
How would you prefer to be contacted?

Other
Relationship to bank?
Account Number(s)
- Co-Applicant Name
  
  First NameLast Name
- Co-Applicant SSN
- Co-Applicant Birthdate
  
  MonthDayYear
  Date
- Co-Applicant Home Address
  
  Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Co-Applicant Email
  example@example.com
- Co-Applicant Phone
  Format: (000) 000-0000.
- Relationship to Applicant
- Name of Person
  
  First NameLast Name
- Home Address
  
  Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- E-mail Address
  example@example.com
- Phone Number
  Format: (000) 000-0000.
- Relationship to Applicant
- Employer Name
- Employer Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Approximate Monthly Income

Employment & Income
Employment
Name of Employer
Employer Phone
Format: (000) 000-0000.
Employer Address

Employers Street

Street Address Line 2

Employers CityEmployers State

Employers Zip
Position / Title
Length of Employment (Years / Months)
Gross Monthly Salary / Wages
Other Monthly Income (Bonus, Commission, etc.)
Do not include income from alimony, child support, or separate maintenance unless you wish to have such income considered.
Other Income Description (source, frequency)
- Employment
- Name of Employer
- Employer Phone
  Format: (000) 000-0000.
- Employer Address
  
  Employers Street
  
  Street Address Line 2
  
  Employers CityEmployers State
  
  Employers Zip
- Position / Title
- Length of Employment (Years / Months)
- Gross Monthly Salary / Wages
- Other Monthly Income (Bonus, Commission, etc.)
  Do not include income from alimony, child support, or separate maintenance unless you wish to have such income considered.
- Other Income Description (source, frequency)

Assets

If you are co-applying, these questions apply to both the applicant and co-applicant.
Cash & Cash Equivalents
Cash on Hand
Checking Accounts (Total)
Savings / Money Market Accounts (Total)
List Banks and Account Types (optional)
Investments & Retirement
Marketable Securities (Stocks, Mutual Funds, Bonds)
Retirement Accounts (401k, IRA, etc.)
Cash Value of Life Insurance
Investment / Retirement Account Details (optional)
Real Estate
Personal Residence (Est. Market Value)
Other Real Estate (Est. Market Value)
Other Real Estate Description (Address, Type, Ownership %)
Business Interest & Personal Property
Ownership in Closely Held Businesses (Total Est. Value)
Automobiles / Vehicles (Total Est. Value)
Personal Property (Furniture, Jewelry, etc.)
Other Assets (Describer Below)
Other Assets Description

Liabilities

If you are co-applying, these questions apply to both the applicant and co-applicant.
Real Estate Debt
Mortgage on Personal Residence (Current Balance)
Home Equity Line of Credit (HELOC)
Mortgages on Other Real Estate (Total Current Balance)
Installment & Revolving Debt

Total Current Balances
Automobile Loans
Student Loans
Credit Cards / Revolving Debt
Other Installment Loans
Other Obligations
Taxes Payable (Federal, State, Local)
Other Liabilities (Describe Below)
Other Liabilities Description

Monthly Income & Expenses Summary

If you are co-applying, these questions apply to both the applicant and co-applicant.
Monthly Income
Total Gross Monthly Salary/Wages
Other Monthly Income
Portion of Total Monthly Income Coming from Other Person
Monthly Expenses
Mortgage / Rent Payment
Other Real Estate Payments
Automobile Loan Payments
Credit Card / Revolving Debt Payments
Installment Loan Payments
Alimony / Child Support / Separate Maintenance (if you wish to disclose)
Family Living / Household Expenses (Est. Monthly)
Other Monthly Obligations (Describe Below)
Other Monthly Obligations Description

TOTALS
Net Worth
Total Monthly Income
Total Monthly Expense

Certification & Authorization
I/We certify that all information provided in this financial statement, including any attachments, is true, correct, and complete to the best of my/our knowledge. I/We understand that Peoples Bank of Kentucky, Inc. (“Bank”) will rely on this information in evaluating my/our creditworthiness.

I/We authorize the Bank to obtain consumer reports and to make any other inquiries it considers necessary and appropriate, to the extent permitted by law, for the purpose of (1) evaluating this application for credit, (2) reviewing, renewing, or increasing any credit that may be extended, and (3) collecting any amounts owed. I/We authorize the Bank to verify any information contained in this statement, including contacting my/our employer(s), creditors, and financial institutions, and, if I am relying on the income or assets of another person, the employer(s) and financial institutions of that person as appropriate and permitted by law.

I/We further authorize the Bank to provide information regarding its credit experience with me/us to credit reporting agencies and to other creditors, as permitted by law. I/We agree to promptly notify the Bank in writing of any material change in the information provided in or with this statement and to furnish such additional information as the Bank may reasonably request.

By signing below, I/We acknowledge that I/We have read, understand, and agree to the above Certification & Authorization.
Applicant Signature
Co-Applicant Signature
Date

MonthDayYear
Date
Date

MonthDayYear
Date
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